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NPI Code Detail

MEDICARE: GREGORY A. SPENCER MD

MEDICARE: GREGORY A. SPENCER 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
1207R00000XInternal Medicine Physician203162NY

Other Identifiers

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

General Provider Information

NPI Number : 1194725168
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREGORY A. SPENCER MD
Provider Business Mailing Address
First Line : 155 CRYSTAL RUN RD
Second Line :
City : MIDDLETOWN
State : NY
Zip : 10941-4028
Country : US
Telephone Number : 845-703-6999
Fax Number : 845-703-6297
Provider Business Practice Location Address
First Line : 155 CRYSTAL RUN RD
Second Line :
City : MIDDLETOWN
State : NY
Zip : 10941-4028
Country : US
Telephone Number : 845-703-6999
Fax Number : 845-703-6297
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2005
Last Update Date : 10/16/2020

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