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1043213465

NPI Code Detail

MEDICARE: DR. DEAN W. SPENCER M.D.

MEDICARE: DR. DEAN W. SPENCER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD043648L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080074407	OTHER	PA	PALMETTO GBA-RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	148780	OTHER	PA	UNISON HEALTH PLAN
3	20047 FCN	OTHER	PA	EPSDT
4	205044	OTHER	PA	UPMC HEALTH PLAN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	559582	OTHER	PA	HIGHMARK BLUE CROSS BLUE SHIELD
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	117608	OTHER	PA	UNISON HEALTH PLAN
9	1119995	OTHER	PA	CIGNA
10	902560	OTHER	PA	HIGHMARK BLUE CROSS BLUE SHIELD
11	A16806	OTHER	PA	HEALTH AMERICA
12	84502	OTHER	PA	HEALTH AMERICA
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	251754199019	OTHER	PA	MEDICAL MUTUAL OF OHIO
15	4235190002	OTHER	PA	NATIONAL SUPPLIERS CLEARINGHOUSE

General Provider Information

NPI Number	:	1043213465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEAN W. SPENCER M.D.

Provider Business Mailing Address
First Line	:	1012 WATER ST
Second Line	:
City	:	MEADVILLE
State	:	PA
Zip	:	16335-3468
Country	:	US
Telephone Number	:	814-336-5995
Fax Number	:	814-333-1025

Provider Business Practice Location Address
First Line	:	1012 WATER ST
Second Line	:
City	:	MEADVILLE
State	:	PA
Zip	:	16335-3468
Country	:	US
Telephone Number	:	814-382-3100
Fax Number	:	814-382-0872

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	06/09/2020

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1881026730 — ZACHARY R MATTERN PT
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Directions to “ DR. DEAN W. SPENCER M.D.” Practice Location

Language	Start Address	Practice Location

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