Provider Demographics
NPI:1528049822
Name:SPEICHER, JOSEPH MICHAEL (D,O,)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:SPEICHER
Suffix:
Gender:M
Credentials:D,O,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:PA
Mailing Address - Zip Code:18801
Mailing Address - Country:US
Mailing Address - Phone:570-278-3801
Mailing Address - Fax:570-278-4312
Practice Address - Street 1:100 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:PA
Practice Address - Zip Code:18801
Practice Address - Country:US
Practice Address - Phone:570-278-3801
Practice Address - Fax:570-278-4312
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004654L207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0964357Medicaid
B95811Medicare UPIN
PASP000626Medicare PIN