Provider Demographics
NPI:1285717074
Name:SPINNEY, CARMEN (MD)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:SPINNEY
Suffix:
Gender:F
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 430
Mailing Address - Street 2:
Mailing Address - City:AVIS
Mailing Address - State:PA
Mailing Address - Zip Code:17721-0430
Mailing Address - Country:US
Mailing Address - Phone:570-753-5000
Mailing Address - Fax:570-753-3475
Practice Address - Street 1:3001 WOODWARD AVE.
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745
Practice Address - Country:US
Practice Address - Phone:570-753-5000
Practice Address - Fax:570-753-3475
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033890L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00153396OtherRAILROAD MEDICARE
PA0010467570002Medicaid
PA002669OtherFIRST PRIORITY HEALTH
PA18176OtherGEISINGER HEALTH PLAN
PA5445312OtherAETNA
PA131918OtherBLUE SHIELD
PAB37723Medicare UPIN
PA131918OtherBLUE SHIELD