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General NPI Number Information
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NPI Number | 1295785251
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Entity Type | Individual
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Provider Name | JOEL S SPELLUN M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 08/16/2019
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Provider Practice Location Address
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Address Line | 148 W RIVER ST SUITE 3
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City | PROVIDENCE
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State | RI
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Zip | 02904-2609
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Country | US
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Telephone | 401-421-6306
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Fax | 401-453-0330
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Provider Business Mailing Address
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Address Line | 148 W RIVER ST SUITE 3
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City | PROVIDENCE
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State | RI
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Zip | 02904-2609
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 7075
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License Number State | RI
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