Healthcare Provider Details

I. General information

NPI: 1528068376
Provider Name (Legal Business Name): CHRISTOPHER SPEVAK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 ROCKVILLE PIKE
BETHESDA MD
20889-2113
US

IV. Provider business mailing address

8901 WISCONSIN AVE
BETHESDA MD
20889
US

V. Phone/Fax

Practice location:
  • Phone: 301-319-2845
  • Fax:
Mailing address:
  • Phone: 202-444-8640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME67116
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME67116
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number31457
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: