MEDICARE: SPECTRUM PEDIATRICS, LLC

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	261QP2300X	Primary Care Clinic/Center	D0056323	MD
2	208000000X	Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962502666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECTRUM PEDIATRICS, LLC

Provider Business Mailing Address
First Line	:	5 EXECUTIVE PARK CT
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20874-2643
Country	:	US
Telephone Number	:	301-916-9696
Fax Number	:	301-515-8866

Provider Business Practice Location Address
First Line	:	5 EXECUTIVE PARK COURT
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20874-2639
Country	:	US
Telephone Number	:	301-916-9696
Fax Number	:	301-916-5533

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LISA LIXIN ZHENG
Credential	:	M.D.
Telephone Number	:	301-916-9696

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	05/02/2024

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