Provider Demographics
NPI:1962502666
Name:SPECTRUM PEDIATRICS, LLC
Entity type:Organization
Organization Name:SPECTRUM PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:LIXIN
Authorized Official - Last Name:ZHENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-916-9696
Mailing Address - Street 1:5 EXECUTIVE PARK CT
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2643
Mailing Address - Country:US
Mailing Address - Phone:301-916-9696
Mailing Address - Fax:301-515-8866
Practice Address - Street 1:5 EXECUTIVE PARK COURT
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2639
Practice Address - Country:US
Practice Address - Phone:301-916-9696
Practice Address - Fax:301-916-5533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0056323261QP2300X
208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD789500301Medicaid