MEDICARE: IRENA SPEKTOR MD

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	207N00000X	Dermatology Physician	053611	GA

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

General Provider Information

NPI Number	:	1720196249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENA SPEKTOR MD

Provider Business Mailing Address
First Line	:	3495 PIEDMONT ROAD NE
Second Line	:	NINE PIEDMONT CENTER
City	:	ATLANTA
State	:	GA
Zip	:	30305-1796
Country	:	US
Telephone Number	:	404-364-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 CUMBERLAND PARKWAY
Second Line	:	KAISER PERMANENTE CUMBERLAND MEDICAL CENTER
City	:	ATLANTA
State	:	GA
Zip	:	30339
Country	:	US
Telephone Number	:	770-431-4330
Fax Number	:	770-431-4193

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	02/09/2022

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