Healthcare Provider Details

I. General information

NPI: 1104180595
Provider Name (Legal Business Name): MARC SCOTT SPIEGEL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 12/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 CENTRE ST
BROCKTON MA
02302-3308
US

IV. Provider business mailing address

145 ROSEMARY ST STE B
NEEDHAM MA
02494-3259
US

V. Phone/Fax

Practice location:
  • Phone: 508-941-7885
  • Fax: 508-941-6337
Mailing address:
  • Phone: 781-444-1129
  • Fax: 781-444-3666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2431
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: