Provider Demographics
NPI:1780390120
Name:SPENCER, LAFARRIS (MR)
Entity type:Individual
Prefix:
First Name:LAFARRIS
Middle Name:
Last Name:SPENCER
Suffix:
Gender:M
Credentials:MR
Other - Prefix:
Other - First Name:LAFARRIS
Other - Middle Name:
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ZONE17TRANSPORTATION
Mailing Address - Street 1:3940 NEMO RD
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4041
Mailing Address - Country:US
Mailing Address - Phone:443-922-0909
Mailing Address - Fax:
Practice Address - Street 1:3940 NEMO RD
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-4041
Practice Address - Country:US
Practice Address - Phone:443-922-0909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT00540238343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)