Basic Information
| Provider Information | |||||||||
| NPI: | 1629140843 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPENGLER | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 655 | ||||||||
| Address2: | |||||||||
| City: | EXETER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038330655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037787975 | ||||||||
| FaxNumber: | 6037787964 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 ALUMNI DR | ||||||||
| Address2: | STE 301 | ||||||||
| City: | EXETER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038332128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037787975 | ||||||||
| FaxNumber: | 6037787964 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2006 | ||||||||
| LastUpdateDate: | 09/22/2009 | ||||||||
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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 | 207X00000X | 5533 | NH | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00000559 | 05 | NH | MEDICAID | 0104377Y0NH01 | 01 | ANTHEM BS | OTHER | 020336308 | 01 | TAX ID# | OTHER | 100833000 | 01 | US DEPARTMENT OF LABOR | OTHER | 200007671 | 01 | RAILROAD MEDICARE | OTHER | 0904133 | 01 | UNITED HEALTHCARE | OTHER | 4680 | 01 | CIGNA NH | OTHER | 0122210 | 01 | AETNA | OTHER |