Provider Demographics
NPI:1871575696
Name:SPITZ, ROBERT M (MD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:M
Last Name:SPITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 MONTAUK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4706
Mailing Address - Country:US
Mailing Address - Phone:860-442-9646
Mailing Address - Fax:860-439-0747
Practice Address - Street 1:342 MONTAUK AVE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4706
Practice Address - Country:US
Practice Address - Phone:860-442-9646
Practice Address - Fax:860-439-0747
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT22751174400000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT603336OtherCONNECTICARE
CT001227511Medicaid
CT030641OtherHEALTHNET
CT001227511-00OtherBLUE CROSS FAMILY PLAN
CTP368544OtherOXFORD
CT160014097OtherRAILROAD MEDICARE
CT010022751CT02OtherANTHEM BLUE CROSS
CT0467494OtherAETNA
CT010022751CT02OtherANTHEM BLUE CROSS
CTB38085Medicare UPIN