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General NPI Number Information
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NPI Number | 1336797182
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Entity Type | Individual
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Provider Name | MRS. LORETTA IRENE SPESSARD
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Gender | Female
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Dates
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Enumeration Date | 08/26/2019
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Last Update Date | 08/26/2019
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Provider Practice Location Address
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Address Line | 664 TRAFALGAR DR
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City | HAGERSTOWN
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State | MD
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Zip | 21742-1230
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Country | US
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Telephone | 17-971-8853
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Fax |
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Provider Business Mailing Address
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Address Line | 664 TRAFALGAR DR
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City | HAGERSTOWN
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State | MD
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Zip | 21742-1230
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Country | US
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Telephone | 301-797-1885
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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 | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number |
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License Number State |
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