=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679571657
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PETER G. SPERANDIO M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2005
-----------------------------------------------------
Last Update Date | 08/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 102 E CENTRE BLVD.
-----------------------------------------------------
City | MARLTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08053-4129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-988-6260
-----------------------------------------------------
Fax | 586-988-6270
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 102 E CENTRE BLVD.
-----------------------------------------------------
City | MARLTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08053-4129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-988-6260
-----------------------------------------------------
Fax | 586-988-6270
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 25MA05565100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------