Provider Demographics
NPI: | 1982798377 |
---|---|
Name: | SPEARMAN, MARIDEE J (MD) |
Entity type: | Individual |
Prefix: | |
First Name: | MARIDEE |
Middle Name: | J |
Last Name: | SPEARMAN |
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: | 800 N JUSTICE ST # 16 |
Mailing Address - Street 2: | |
Mailing Address - City: | HENDERSONVILLE |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28791-3410 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 828-694-8350 |
Mailing Address - Fax: | 828-694-7654 |
Practice Address - Street 1: | 800 N JUSTICE ST |
Practice Address - Street 2: | |
Practice Address - City: | HENDERSONVILLE |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28791 |
Practice Address - Country: | US |
Practice Address - Phone: | 828-694-8350 |
Practice Address - Fax: | 828-694-7654 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-10-03 |
Last Update Date: | 2018-12-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 2008-01095 | 207VG0400X, 207V00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | |
No | 207VG0400X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NM | 82178763 | Medicaid | |
NC | 2022993 | Other | MEDICARE PTAN |
I04472 | Medicare UPIN |