Provider Demographics
NPI:1831259209
Name:SPECTOR, ROBERT TODD (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:TODD
Last Name:SPECTOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 E ERIE AVE DEPT OF
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-1011
Mailing Address - Country:US
Mailing Address - Phone:215-427-2020
Mailing Address - Fax:215-427-8128
Practice Address - Street 1:160 E ERIE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-1011
Practice Address - Country:US
Practice Address - Phone:215-427-2020
Practice Address - Fax:215-427-8128
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD440490207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001196815Medicaid
CT010019681CT04OtherANTHEM BCBS
CT2285956OtherAETNA
CT001196815Medicaid
CT2285956OtherAETNA