Provider Demographics
NPI:1790872489
Name:SPITZER, IRA EDWARD (DO)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:EDWARD
Last Name:SPITZER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 MIDDLETOWN BLVD
Mailing Address - Street 2:SUITE 504
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047
Mailing Address - Country:US
Mailing Address - Phone:215-750-0315
Mailing Address - Fax:215-702-1062
Practice Address - Street 1:370 MIDDLETOWN BLVD
Practice Address - Street 2:SUITE 504
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:215-750-0315
Practice Address - Fax:215-702-1062
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003700L207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B37299Medicare UPIN
PA123456Q8PMedicare ID - Type Unspecified