Provider Demographics
NPI:1831148857
Name:SPALDING, MARY CARMEN (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:CARMEN
Last Name:SPALDING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 9520
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79995-9520
Mailing Address - Country:US
Mailing Address - Phone:915-757-2581
Mailing Address - Fax:915-757-4378
Practice Address - Street 1:9849 KENWORTHY ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-4402
Practice Address - Country:US
Practice Address - Phone:915-757-2581
Practice Address - Fax:915-757-4378
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE8927207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127891303Medicaid
TX127891303Medicaid
TX89C560Medicare ID - Type Unspecified