Provider Demographics
NPI:1932161577
Name:SPIEGEL, JEFFREY H (MD)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:H
Last Name:SPIEGEL
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 1:335 BOYLSTON ST
Mailing Address - Street 2:FRONT
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459
Mailing Address - Country:US
Mailing Address - Phone:617-566-3223
Mailing Address - Fax:617-566-3220
Practice Address - Street 1:335 BOYLSTON ST
Practice Address - Street 2:FRONT
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459
Practice Address - Country:US
Practice Address - Phone:617-566-3223
Practice Address - Fax:617-566-3220
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205428207Y00000X, 207YS0123X
261QA1903X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0112020Medicaid
MA0112020Medicaid
MAHX1338Medicare PIN