Individual
MARK PAUL SPEICHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
33-57 HARRISON ST, HOSPITALIST DEPT, JOHNSON CITY, NY 13790-2107
(607) 763-6622
(607) 763-5064
Mailing address
346 GRAND AVE, JOHNSON CITY, NY 13790-2580
(607) 729-8156
(607) 729-3982
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
213917-1
NY
207R00000X
Internal Medicine Physician
OS009551L
PA
208M00000X
Hospitalist Physician
Primary
213917
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017620980002
—
PA
05
—
02052197
—
NY
01
—
110221437
RR MEDICARE PIN
NY
01
—
CC8362
RR MEDICARE GROUP
NY
01
—
P00624424
RR MEDICARE
—
Enumeration date
02/20/2006
Last updated
09/12/2012
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