Provider Demographics
NPI:1043213465
Name:SPENCER, DEAN W (MD)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:W
Last Name:SPENCER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1012 WATER ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3468
Mailing Address - Country:US
Mailing Address - Phone:814-336-5995
Mailing Address - Fax:814-333-1025
Practice Address - Street 1:1012 WATER ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3468
Practice Address - Country:US
Practice Address - Phone:814-382-3100
Practice Address - Fax:814-382-0872
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043648L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA080074407OtherPALMETTO GBA-RAILROAD MEDICARE
PA148780OtherUNISON HEALTH PLAN
PA20047 FCNOtherEPSDT
PA205044OtherUPMC HEALTH PLAN
PA0012575550009Medicaid
PA559582OtherHIGHMARK BLUE CROSS BLUE SHIELD
PA0012575550004Medicaid
PA117608OtherUNISON HEALTH PLAN
PA1119995OtherCIGNA
PA902560OtherHIGHMARK BLUE CROSS BLUE SHIELD
PAA16806OtherHEALTH AMERICA
PA84502OtherHEALTH AMERICA
PA0012575550007Medicaid
PA251754199019OtherMEDICAL MUTUAL OF OHIO
PA4235190002OtherNATIONAL SUPPLIERS CLEARINGHOUSE
PA205044OtherUPMC HEALTH PLAN
PA680938Medicare PIN