Provider Demographics
NPI:1154550648
Name:SPELAR, MARC J (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:J
Last Name:SPELAR
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 1:511 MORRIS ST
Mailing Address - Street 2:DEPARTMENT OF BEHAVIORAL MEDICINE
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1326
Mailing Address - Country:US
Mailing Address - Phone:304-341-0511
Mailing Address - Fax:
Practice Address - Street 1:5600 US ROUTE 60
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2146
Practice Address - Country:US
Practice Address - Phone:304-399-1177
Practice Address - Fax:304-399-3700
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT195698390200000X
WV252642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0005355002Medicaid
WV0005355002Medicaid