Basic Information
| Provider Information | |||||||||
| NPI: | 1558303727 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPELLMAN | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | LEWIS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1615 ORANGE TREE LN | ||||||||
| Address2: | |||||||||
| City: | REDLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923744501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9097860725 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7000 BOULDER AVE | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098621191 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 05/15/2018 | ||||||||
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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 | 2084N0400X | 031860 | CT | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 250952200 | 01 | DEPT OF LABOR | OTHER | 061325634 | 01 | COMM INS | OTHER | 061325634 | 01 | UNITED HEALTH | OTHER | 010031860CT01 | 01 | BLUE CROSS ANTHEM | OTHER | 061325634 | 01 | CHAMPUS | OTHER | 140400 | 01 | WORK COMP | OTHER | NHS133 | 01 | OXFORD | OTHER | 031860 | 01 | CONNECTI CARE | OTHER | 130009173 | 01 | RR MEDICARE | OTHER | 001318600 | 05 | CT | MEDICAID | 00131860000 | 01 | BLUE CROSS FAMILY PLAN | OTHER | 0983647004 | 01 | CIGNA | OTHER | 061325634 | 01 | COMMUNITY HEALTH | OTHER | 06132S634 | 01 | AETNA | OTHER | 0613Z5634 | 01 | FIRST HEALTH | OTHER | OR0088 | 01 | HEALTHNET | OTHER |