Provider Demographics
NPI:1871697946
Name:SPECHT, EVANGELINE SANTOS (MD)
Entity type:Individual
Prefix:DR
First Name:EVANGELINE
Middle Name:SANTOS
Last Name:SPECHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MA. EVANGELINE
Other - Middle Name:S
Other - Last Name:SPECHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:60 SKY LINE DR
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:CT
Mailing Address - Zip Code:06612-1056
Mailing Address - Country:US
Mailing Address - Phone:203-650-7347
Mailing Address - Fax:203-220-9011
Practice Address - Street 1:60 SKY LINE DR
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:CT
Practice Address - Zip Code:06612-1056
Practice Address - Country:US
Practice Address - Phone:203-650-7347
Practice Address - Fax:860-738-5840
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027665207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB37946Medicare UPIN