Provider Demographics
NPI:1205897402
Name:SPANGLER, PHILLIP R (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:R
Last Name:SPANGLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 GREAT TEAYS BLVD
Mailing Address - Street 2:STE 6
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-9815
Mailing Address - Country:US
Mailing Address - Phone:304-757-6999
Mailing Address - Fax:304-201-5019
Practice Address - Street 1:2 CHATEAU LN
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1626
Practice Address - Country:US
Practice Address - Phone:304-736-9662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV209152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2489883Medicaid
WVWV2714GOtherMEDICARE PTAN
WVWV2714HOtherMEDICARE PTAN
WV2006085000Medicaid
WVWV2714DOtherMEDICARE PTAN
WVWV2714FOtherMEDICARE PTAN
WVWV2714EOtherMEDICARE PTAN
WVWV2714EOtherMEDICARE PTAN
WV2006085000Medicaid
WVH96726Medicare UPIN