Provider Demographics
NPI:1962609545
Name:HARVEY M SPECTOR DO PC
Entity type:Organization
Organization Name:HARVEY M SPECTOR DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SPECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-673-0556
Mailing Address - Street 1:9622 BUSTLETON AVE
Mailing Address - Street 2:SUITE#3
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-3100
Mailing Address - Country:US
Mailing Address - Phone:215-673-0556
Mailing Address - Fax:215-673-0870
Practice Address - Street 1:9622 BUSTLETON AVE
Practice Address - Street 2:SUITE#3
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-3100
Practice Address - Country:US
Practice Address - Phone:215-673-0556
Practice Address - Fax:215-673-0870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA074992Medicare ID - Type Unspecified