Healthcare Provider Details

I. General information

NPI: 1265414577
Provider Name (Legal Business Name): PAUL JOSHUA SPIEGEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 N PEARL ST
BROCKTON MA
02301-1794
US

IV. Provider business mailing address

819 WORCESTER ST SUITE 3
SPRINGFIELD MA
01151-1045
US

V. Phone/Fax

Practice location:
  • Phone: 508-427-3000
  • Fax:
Mailing address:
  • Phone: 413-543-6820
  • Fax: 413-543-7962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number219913
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number219913
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: