Healthcare Provider Details

I. General information

NPI: 1184667677
Provider Name (Legal Business Name): BARRY MARC SPECTOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 HIGHLANDS DR
LITITZ PA
17543-7694
US

IV. Provider business mailing address

1500 HIGHLANDS DR
LITITZ PA
17543-7694
US

V. Phone/Fax

Practice location:
  • Phone: 717-988-0000
  • Fax: 717-782-5716
Mailing address:
  • Phone: 717-988-0000
  • Fax: 717-782-5716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD032793E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD29282
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierD29282
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerWORKER'S COMP
# 2
Identifier60059304
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerBLUE SHIELD
# 3
Identifier408982100
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: