Provider Demographics
NPI:1336177096
Name:SPEARS, RODERICK C (MD)
Entity type:Individual
Prefix:
First Name:RODERICK
Middle Name:C
Last Name:SPEARS
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 1:110 ELM ST FL 2
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4626
Mailing Address - Country:US
Mailing Address - Phone:401-443-5122
Mailing Address - Fax:401-537-7241
Practice Address - Street 1:900 DOUGLAS PIKE
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-1879
Practice Address - Country:US
Practice Address - Phone:401-618-5507
Practice Address - Fax:401-444-3205
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD181382084N0400X
PAMD4427012084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1336177096Medicaid