Basic Information
| Provider Information | |||||||||
| NPI: | 1205897402 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPANGLER | ||||||||
| FirstName: | PHILLIP | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 97 GREAT TEAYS BLVD | ||||||||
| Address2: | STE 6 | ||||||||
| City: | SCOTT DEPOT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 255609815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047576999 | ||||||||
| FaxNumber: | 3042015019 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 CHATEAU LN | ||||||||
| Address2: | |||||||||
| City: | BARBOURSVILLE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 255041626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047369662 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2006 | ||||||||
| LastUpdateDate: | 11/14/2018 | ||||||||
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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 | 2084P0800X | 20915 | WV | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 2489883 | 05 | WV | MEDICAID | WV2714G | 01 | WV | MEDICARE PTAN | OTHER | WV2714H | 01 | WV | MEDICARE PTAN | OTHER | 2006085000 | 05 | WV | MEDICAID | WV2714D | 01 | WV | MEDICARE PTAN | OTHER | WV2714F | 01 | WV | MEDICARE PTAN | OTHER | WV2714E | 01 | WV | MEDICARE PTAN | OTHER |