Healthcare Provider Details

I. General information

NPI: 1952447070
Provider Name (Legal Business Name): M.LAWRENCE SPOONT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 WOODBURN RD
ANNANDALE VA
22003-1202
US

IV. Provider business mailing address

6460 EPPARD ST
FALLS CHURCH VA
22042-3123
US

V. Phone/Fax

Practice location:
  • Phone: 703-573-5679
  • Fax:
Mailing address:
  • Phone: 703-534-8237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101229161
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: