Provider Demographics
NPI:1245361187
Name:PENN, SPENCER L (DO)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:L
Last Name:PENN
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 1:15 CAMPUS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-3200
Mailing Address - Country:US
Mailing Address - Phone:484-420-2554
Mailing Address - Fax:
Practice Address - Street 1:15 CAMPUS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3200
Practice Address - Country:US
Practice Address - Phone:484-420-2554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013973207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine