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General NPI Number Information
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NPI Number | 1528235199
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Entity Type | Organization
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Legal Business Name | SUSAN J SPENCER, MD, INC
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Dates
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Enumeration Date | 05/13/2008
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Last Update Date | 08/27/2010
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Provider Practice Location Address
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Address Line | 101 S SAN MATEO DR STE 112
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City | SAN MATEO
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State | CA
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Zip | 94401-3840
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Country | US
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Telephone | 650-344-3325
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Fax | 650-344-7802
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Provider Business Mailing Address
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Address Line | 101 S SAN MATEO DR STE 112
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City | SAN MATEO
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State | CA
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Zip | 94401-3840
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Country | US
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Telephone | 650-344-3325
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Fax | 650-344-7802
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUSAN J SPENCER
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Credential | M.D.
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Telephone | 650-344-3325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | G065695
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License Number State | CA
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