MEDICARE: SPECTRUM PROFESSIONAL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1336432699
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECTRUM PROFESSIONAL SERVICES

Provider Business Mailing Address
First Line	:	3970 POST RD
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-9235
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3970 POST RD
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-9235
Country	:	US
Telephone Number	:	401-648-4677
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CORY GELMAN
Credential	:
Telephone Number	:	401-642-3977

Provider Enumeration Date	:	05/19/2011
Last Update Date	:	05/19/2011

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Directions to “SPECTRUM PROFESSIONAL SERVICES ” Practice Location

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