Provider Demographics
NPI:1174594980
Name:SPATARO, JOSEPH DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DAVID
Last Name:SPATARO
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 1:6101 IDLEWILD RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-0517
Mailing Address - Country:US
Mailing Address - Phone:704-531-0990
Mailing Address - Fax:704-531-0464
Practice Address - Street 1:6101 IDLEWILD RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-0517
Practice Address - Country:US
Practice Address - Phone:704-531-0990
Practice Address - Fax:704-531-0464
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15313208D00000X
NC208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8913379Medicaid
2026127Medicare ID - Type UnspecifiedMEDICARE NUMBER
NC8913379Medicaid