Provider Demographics
NPI:1487685624
Name:SPERAZZA, DAL S (MD)
Entity Type:Individual
Prefix:
First Name:DAL
Middle Name:S
Last Name:SPERAZZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 REAR WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-3602
Mailing Address - Country:US
Mailing Address - Phone:570-714-2166
Mailing Address - Fax:570-714-2177
Practice Address - Street 1:525 REAR WYOMING AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3602
Practice Address - Country:US
Practice Address - Phone:570-714-2166
Practice Address - Fax:570-714-2177
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036948L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005540270007Medicaid
PA075825OtherFIRST PRIORITY HEALTH
PA100651OtherHIGHMARK BLUE SHIELD
PAAA4036005OtherUNITED HEALTH CARE
PA100651OtherFIRST PRIORITY LIFE INS
PAP024073OtherTRICARE
PA20013574OtherAMERIHEALTH ADMINISTRATOR
PA20013574OtherAMERIHEALTH ADMINISTRATOR
PAE11461Medicare UPIN
PA100651Medicare PIN