MEDICARE: MR. TIMOTHY J SPERO PHYSICAN ASSISTANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	OA002140	PA
2	363A00000X	Physician Assistant	MA052806	PA

General Provider Information

NPI Number	:	1972648541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY J SPERO PHYSICAN ASSISTANT

Provider Business Mailing Address
First Line	:	325 W GERMANTOWN PIKE
Second Line	:	SUITE 100
City	:	EAST NORRISTOWN
State	:	PA
Zip	:	19403
Country	:	US
Telephone Number	:	610-272-1881
Fax Number	:	610-275-8819

Provider Business Practice Location Address
First Line	:	325 WEST GERMANTOWN PIKE
Second Line	:	SUITE 100
City	:	EAST NORRISTOWN
State	:	PA
Zip	:	19403
Country	:	US
Telephone Number	:	610-272-1881
Fax Number	:	610-275-8819

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	05/24/2011

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