MEDICARE: JONATHAN M SPERGEL 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	207RA0201X	Allergy & Immunology (Internal Medicine) Physician	MD065920L	PA
2	208000000X	Pediatrics Physician	MD065920L	PA
3	2080P0201X	Pediatric Allergy/Immunology Physician	MD065920L	PA
4	208000000X	Pediatrics Physician	25MA06906100	NJ
5	2080P0201X	Pediatric Allergy/Immunology Physician	25MA06906100	NJ
6	207RA0201X	Allergy & Immunology (Internal Medicine) Physician	25MA06906100	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043226996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN M SPERGEL M.D.

Provider Business Mailing Address
First Line	:	100 E PENN SQ
Second Line	:	9TH FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-3323
Country	:	US
Telephone Number	:	267-425-9232
Fax Number	:	267-425-9299

Provider Business Practice Location Address
First Line	:	3550 MARKET ST FL 3
Second Line	:	CHILDREN'S HOSPITAL OF PHILADELPHIA - ALLERGY & IMMUN
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-3365
Country	:	US
Telephone Number	:	215-590-2549
Fax Number	:	215-590-4529

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	04/15/2013

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