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General NPI Number Information
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NPI Number | 1912981630
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Entity Type | Individual
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Provider Name | JONATHAN M SPECTOR M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/06/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 55 LAKE AVE N DEPARTMENT OF PEDIATRICS
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City | WORCESTER
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State | MA
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Zip | 01655-0002
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Country | US
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Telephone | 508-856-3590
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Fax |
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Provider Business Mailing Address
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Address Line | 15 LEE ST #5
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City | CAMBRIDGE
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State | MA
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Zip | 02139-2252
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Country | US
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Telephone | 617-953-9471
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Fax | 508-334-5201
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 205520
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License Number State | MA
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