Provider Demographics
NPI:1952369597
Name:SPEVACK, THEODORE A (DO)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:A
Last Name:SPEVACK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719
Mailing Address - Country:US
Mailing Address - Phone:508-999-1100
Mailing Address - Fax:508-999-7222
Practice Address - Street 1:43 HIGH ST
Practice Address - Street 2:SUITE 250
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-2097
Practice Address - Country:US
Practice Address - Phone:508-273-4680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159275207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine