Provider Demographics
NPI:1093709214
Name:SPOHR, GEORGE E (PA)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:E
Last Name:SPOHR
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7980 STATE ROUTE 12
Mailing Address - Street 2:
Mailing Address - City:BARNEVELD
Mailing Address - State:NY
Mailing Address - Zip Code:13304-2536
Mailing Address - Country:US
Mailing Address - Phone:315-624-2536
Mailing Address - Fax:315-624-8450
Practice Address - Street 1:7980 STATE ROUTE 12
Practice Address - Street 2:
Practice Address - City:BARNEVELD
Practice Address - State:NY
Practice Address - Zip Code:13304-2536
Practice Address - Country:US
Practice Address - Phone:315-624-2536
Practice Address - Fax:315-624-8450
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001648363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01280097Medicaid
S28339Medicare UPIN
NYPA0854Medicare UPIN