Provider Demographics
NPI:1730179532
Name:SPRUIELL, LINWOOD RAY (MD)
Entity type:Individual
Prefix:
First Name:LINWOOD
Middle Name:RAY
Last Name:SPRUIELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 79763
Mailing Address - Street 2:SMG ANESTHESIA SPECIALISTS LLC
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0763
Mailing Address - Country:US
Mailing Address - Phone:757-470-5570
Mailing Address - Fax:757-363-6204
Practice Address - Street 1:2025 GLENN MITCHELL DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0178
Practice Address - Country:US
Practice Address - Phone:757-470-5570
Practice Address - Fax:757-363-6204
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101044236207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5730538Medicaid
VA5730538Medicaid
D80506Medicare UPIN