Provider Demographics
NPI:1962536706
Name:SPENCER, RICHARD GLENN (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GLENN
Last Name:SPENCER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:503 FAIRWAY CT
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-7338
Mailing Address - Country:US
Mailing Address - Phone:410-558-8226
Mailing Address - Fax:
Practice Address - Street 1:5600 NATHAN SHOCK DR
Practice Address - Street 2:GRC 4D-08
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-6825
Practice Address - Country:US
Practice Address - Phone:410-558-8226
Practice Address - Fax:410-558-8318
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0042757207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD183011200Medicaid
MD136113Y9QMedicare PIN