Provider Demographics
NPI:1154385631
Name:SPALDING, MARTIN JOHN (MD,)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:JOHN
Last Name:SPALDING
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2375
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-2375
Mailing Address - Country:US
Mailing Address - Phone:803-936-8146
Mailing Address - Fax:803-936-8916
Practice Address - Street 1:2720 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4810
Practice Address - Country:US
Practice Address - Phone:803-936-8146
Practice Address - Fax:803-936-8916
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111687207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO30544018OtherKANSAS CITY BCBS
KS100428960AMedicaid
MO204837819Medicaid
SC314252Medicaid
KS100428960BMedicaid
KS442180OtherBCBS
KS100428960BMedicaid
MOJ71A00003Medicare PIN
KS442180OtherBCBS
KS100428960AMedicaid
MO30544018OtherKANSAS CITY BCBS
G97B407Medicare PIN
KSJ71000002Medicare PIN