Provider Demographics
NPI:1396728788
Name:SPINA, WILLIAM JOHN (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JOHN
Last Name:SPINA
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 1:181 CORLISS LN
Mailing Address - Street 2:
Mailing Address - City:COLEBROOK
Mailing Address - State:NH
Mailing Address - Zip Code:03576-3207
Mailing Address - Country:US
Mailing Address - Phone:603-237-4971
Mailing Address - Fax:603-237-4594
Practice Address - Street 1:181 CORLISS LN
Practice Address - Street 2:UPPER CONNECTICUT VALLEY HOSPITAL
Practice Address - City:COLEBROOK
Practice Address - State:NH
Practice Address - Zip Code:03576-3207
Practice Address - Country:US
Practice Address - Phone:603-237-4971
Practice Address - Fax:603-237-4145
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH7773207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0005218Medicaid
0101645YONH08OtherANTHEM
NH732381OtherCIGNA
VT1645OtherBCBS
NH785643OtherMVP
D03519OtherHARVARD PIL
NH30002254Medicaid
785645OtherTRICARE
0101645YCNH07OtherW/I/C
NHNH9580Medicare ID - Type Unspecified
NH30002254Medicaid