Provider Demographics
NPI:1851367189
Name:SPIELVOGLE, WILLIAM
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:SPIELVOGLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:FARRELL
Mailing Address - State:PA
Mailing Address - Zip Code:16121-1357
Mailing Address - Country:US
Mailing Address - Phone:724-983-7021
Mailing Address - Fax:724-983-5250
Practice Address - Street 1:2200 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:FARRELL
Practice Address - State:PA
Practice Address - Zip Code:16121-1357
Practice Address - Country:US
Practice Address - Phone:724-983-7021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421223207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009266900001Medicaid
PA1009266900001Medicaid
PA080262J50Medicare ID - Type Unspecified