MEDICARE: DR. JOSEPH DAVID SPATARO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	15313	SC
2	208D00000X	General Practice Physician		NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174594980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH DAVID SPATARO MD

Provider Business Mailing Address
First Line	:	6101 IDLEWILD RD
Second Line	:	SUITE 300
City	:	CHARLOTTE
State	:	NC
Zip	:	28212-0517
Country	:	US
Telephone Number	:	704-531-0990
Fax Number	:	704-531-0464

Provider Business Practice Location Address
First Line	:	6101 IDLEWILD RD
Second Line	:	SUITE 300
City	:	CHARLOTTE
State	:	NC
Zip	:	28212-0517
Country	:	US
Telephone Number	:	704-531-0990
Fax Number	:	704-531-0464

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	10/23/2007

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