Provider Demographics
NPI:1578500849
Name:SPAETH, GEORGE L (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:L
Last Name:SPAETH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:840 WALNUT ST
Mailing Address - Street 2:SUITE 1110
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5109
Mailing Address - Country:US
Mailing Address - Phone:215-928-3197
Mailing Address - Fax:215-928-0166
Practice Address - Street 1:840 WALNUT ST
Practice Address - Street 2:SUITE 1110
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5109
Practice Address - Country:US
Practice Address - Phone:215-928-3197
Practice Address - Fax:215-928-0166
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD006058E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA007303940002Medicaid
PA0053092000OtherKEYSTONE 65
PA0053092000OtherKEYSTONE 65
PA016758Medicare PIN