Provider Demographics
NPI:1518113653
Name:SPOR, ALICIA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:
Last Name:SPOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:GILLESPIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1854 VETERANS HWY
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19056-2107
Mailing Address - Country:US
Mailing Address - Phone:215-752-1600
Mailing Address - Fax:
Practice Address - Street 1:1854 VETERANS HWY
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19056-2107
Practice Address - Country:US
Practice Address - Phone:215-752-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053402363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical