Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD-064519-L | PA |
NPI | 1003812132 |
---|---|
Provider Name | Dr. Alexander Spasic |
First Address | Carlisle, PA 17015-6943 |
Second Address | Carlisle, PA 17015-6943 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2005 |
Last Update Date | 04/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1012106780001 | (05) | PA |
G50840 | (02) | PA |
MD-064519-L | PA LICENSE NUMBER (01) | PA |