Healthcare Provider Details

I. General information

NPI: 1962502666
Provider Name (Legal Business Name): SPECTRUM PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 EXECUTIVE PARK COURT
GERMANTOWN MD
20874-2639
US

IV. Provider business mailing address

5 EXECUTIVE PARK CT
GERMANTOWN MD
20874-2643
US

V. Phone/Fax

Practice location:
  • Phone: 301-916-9696
  • Fax: 301-916-5533
Mailing address:
  • Phone: 301-916-9696
  • Fax: 301-515-8866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberD0056323
License Number StateMD

VIII. Authorized Official

Name: DR. LISA LIXIN ZHENG
Title or Position: OWNER
Credential: M.D.
Phone: 301-916-9696