Basic Information
| Provider Information | |||||||||
| NPI: | 1861667065 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPENCER-MANZON | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3643 NORTH ROXBORO ROAD | ||||||||
| Address2: | DUKE REGIONAL HOSPITAL MEDICINE | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277040001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194708490 | ||||||||
| FaxNumber: | 9194708469 | ||||||||
| Practice Location | |||||||||
| Address1: | 3643 N ROXBORO ST | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277042702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194708490 | ||||||||
| FaxNumber: | 9194708469 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2008 | ||||||||
| LastUpdateDate: | 01/17/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 122192 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207SG0201X | 122192 | NC | N | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Genetics (M.D.) | 207SG0202X | 2008-01116 | NC | N | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Biochemical Genetics |
ID Information
| ID | Type | State | Issuer | Description | 5909828 | 05 | NC | MEDICAID |