Provider Demographics
NPI:1962718734
Name:SPANGLER, ELIZABETH LEE (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LEE
Last Name:SPANGLER
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:501 MORRIS ST
Mailing Address - Street 2:OFFICE OF MEDICAL AFFAIRS
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1326
Mailing Address - Country:US
Mailing Address - Phone:304-388-7177
Mailing Address - Fax:304-388-7175
Practice Address - Street 1:501 MORRIS ST
Practice Address - Street 2:OFFICE OF MEDICAL AFFAIRS
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1326
Practice Address - Country:US
Practice Address - Phone:304-388-7177
Practice Address - Fax:304-388-7175
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WVWV15235207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVG01186Medicare UPIN