Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 0103000983 | VA |
N | 213ES0131X | Foot Surgery | SC0032299L | PA |
NPI | 1265538979 |
---|---|
Provider Name | Paul Thomas Spada |
First Address | Virginia Beach, VA 23464-2227 |
Second Address | Virginia Beach, VA 23464-2227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 10/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009300449 | (05) | VA |
330051 | BC/BS # (01) | VA |
480027059 | RAILROAD M/C # (01) | VA |
U26131 | (02) | VA |