Individual
JERRY SPIVAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
600 N WOLFE ST, BALTIMORE, MD 21287-0005
(410) 955-3142
Mailing address
PO BOX 64264, BALTIMORE, MD 21264-4264
(410) 955-3142
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
D03781
MD
207RH0000X
Hematology (Internal Medicine) Physician
Primary
D03781
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
711651900
—
MD
Enumeration date
07/05/2006
Last updated
02/19/2013
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