Provider Demographics
NPI:1497832240
Name:SPACK, NORMAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:P
Last Name:SPACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 SALISBURY RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-2107
Mailing Address - Country:US
Mailing Address - Phone:617-738-6022
Mailing Address - Fax:
Practice Address - Street 1:333 LONGWOOD AVE
Practice Address - Street 2:FLOOR 6
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5711
Practice Address - Country:US
Practice Address - Phone:617-355-5070
Practice Address - Fax:617-730-0194
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA36582208000000X, 2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2045760Medicaid
A67381Medicare UPIN
M09275Medicare ID - Type Unspecified