Basic Information
| Provider Information | |||||||||
| NPI: | 1144206699 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ERMAN | ||||||||
| FirstName: | SPENCER | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 339 W MAIN ST | ||||||||
| Address2: | HARTFORD MEDICAL GROUP | ||||||||
| City: | AVON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060014322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606962150 | ||||||||
| FaxNumber: | 8606962160 | ||||||||
| Practice Location | |||||||||
| Address1: | 339 W MAIN ST | ||||||||
| Address2: | HARTFORD MEDICAL GROUP | ||||||||
| City: | AVON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060014322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606962150 | ||||||||
| FaxNumber: | 8606962160 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2005 | ||||||||
| LastUpdateDate: | 10/25/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 029344 | CT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001293448 | 05 | CT | MEDICAID |