Provider Demographics
NPI:1093696114
Name:SPITALIERE, MARCO ANTONIO (NBC HIS)
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:ANTONIO
Last Name:SPITALIERE
Suffix:
Gender:M
Credentials:NBC HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 W MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043-2580
Mailing Address - Country:US
Mailing Address - Phone:828-447-7716
Mailing Address - Fax:
Practice Address - Street 1:1512 W MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-2580
Practice Address - Country:US
Practice Address - Phone:828-447-7716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1721237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist