Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 0080761 | NY |
NPI | 1003885385 |
---|---|
Provider Name | Ms. Melissa Ann Spencer |
First Address | Williamsville, NY 14221-4133 |
Second Address | Williamsville, NY 14221-4133 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 06/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q04409 | (02) | NY |