Michael Spack, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

C0001119 Issued in MD

Practice address

1342 South Division Street
Unit 401, Peninsula Urology Associates PA
Salisbury, MD 21084

Phone

(410) 546-2133

Fax

(410) 548-3361

NPI assigned

Mar 27, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Peninsula Surgical Group, P.a.

  • Mammography Clinic/Center
  • Salisbury, MD
  • NPI 1811084304
  NPD (past)
• Peninsula Surgical Group, P.a.

  • Surgery Physician
  • Salisbury, MD
  • NPI 1962484428
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1073573572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1342 SOUTH DIVISION STREET",
            "address_2": "UNIT 401, PENINSULA UROLOGY ASSOCIATES PA",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "21084",
            "telephone_number": "410-546-2133",
            "fax_number": "410-548-3361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1342 SOUTH DIVISION STREET",
            "address_2": "UNIT 401, PENINSULA UROLOGY ASSOCIATES PA",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "21084",
            "telephone_number": "410-546-2133",
            "fax_number": "410-548-3361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPACK",
        "first_name": "MICHAEL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-27",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0001119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shahabuddin Soherwardi, MD
• Cassidy Bret Soistman, LCSW-C
• Lori A Soley, CRNP MS
• Sophia Sonen, LCADC
• Southside Medical Care LLC
• Christine Speicher
• Jeffrey Vahan Spencer, MD
• Gwynn D Sperandeo
• Clare Spillane, LCSW-C
• Lori Ann Sportelli, OD

• Physician Assistant in Salisbury, MD
• Providers in Salisbury, MD by specialty
• Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.