Healthcare Provider Details

I. General information

NPI: 1861597072
Provider Name (Legal Business Name): SPECTRUM MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BRIDGE ST STE 300
DANVILLE VA
24541-1222
US

IV. Provider business mailing address

109 BRIDGE ST STE 300
DANVILLE VA
24541-1222
US

V. Phone/Fax

Practice location:
  • Phone: 434-793-4711
  • Fax: 434-797-2514
Mailing address:
  • Phone: 434-793-4711
  • Fax: 434-797-2514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number0128376 1
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number0128376 1
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number0128376 1
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0128376 1
License Number StateVA
# 6
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0128376 1
License Number StateVA

VIII. Authorized Official

Name: DR. MARK C HERMANN
Title or Position: PHYSICIAN
Credential: MD
Phone: 434-793-4711