Individual ProviderGregory SpisakInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address4300 Londonderry Rd, Harrisburg, PA 17109-5317(717) 231-8772PECOS EnrollmentBased on the most recent information from CMS, provider Gregory Spisak is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 15 days ago.Profile DetailsProvider ID1922412378Provider TypeIndividualFull NameSpisak, GregoryTitleDr.CredentialD.O.GenderMaleSole ProprietorNoEnumeration Date6/13/2014Last Updated12/10/2018Contact InformationPractice LocationPractice Address4300 Londonderry Rd, Harrisburg, PA 17109-5317Phone(717) 231-8772Fax(717) 231-8435Mailing LocationMailing Address409 S 2nd St Ste 2f, Harrisburg, PA 17104-1612PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicenseOS018857PennsylvaniaCode207R00000XDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense0116027206VirginiaProvider IdentifiersIDDescriptionIssuerID103321101DescriptionMedicaidIssuerUnlistedPennsylvania