MEDICARE: MR. EDWARD ROBIN SPEARMAN

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	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1639146632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWARD ROBIN SPEARMAN

Provider Business Mailing Address
First Line	:	908 EDGERTON RD
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-6034
Country	:	US
Telephone Number	:	757-543-0819
Fax Number	:

Provider Business Practice Location Address
First Line	:	1721 TAUSSIG BLVD
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23511
Country	:	US
Telephone Number	:	757-953-8753
Fax Number	:

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

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	07/08/2007

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