Provider Demographics
NPI:1194064923
Name:SPAEDER, MICHAEL GEORGE (PA-C)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GEORGE
Last Name:SPAEDER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1550 RODNEY RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17408-9715
Mailing Address - Country:US
Mailing Address - Phone:717-846-8791
Mailing Address - Fax:717-845-1093
Practice Address - Street 1:1550 RODNEY RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-9715
Practice Address - Country:US
Practice Address - Phone:717-846-8791
Practice Address - Fax:717-845-1093
Is Sole Proprietor?:No
Enumeration Date:2013-02-14
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002025L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2886481OtherPA BS
PA50115603OtherPA PC
PA043581HOZMedicare PIN