Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0201X | Internist - Allergy & Immunology | 25MA06906100 | NJ |
N | 207RA0201X | Internist - Allergy & Immunology | MD065920L | PA |
N | 208000000X | Pediatrician | 25MA06906100 | NJ |
N | 208000000X | Pediatrician | MD065920L | PA |
N | 2080P0201X | Pediatric Allergist | 25MA06906100 | NJ |
Y | 2080P0201X | Pediatric Allergist | MD065920L | PA |
NPI | 1043226996 |
---|---|
Provider Name | Jonathan M Spergel |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-3365 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 15/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001699833 | (05) | PA |
7684908 | (05) | NJ |
G76447 | (02) |