Provider Demographics
NPI:1326155599
Name:SPECTRUM FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:SPECTRUM FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:BAIER
Authorized Official - Last Name:O'CONOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-738-0300
Mailing Address - Street 1:9715 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 501
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3320
Mailing Address - Country:US
Mailing Address - Phone:301-738-0300
Mailing Address - Fax:301-738-1316
Practice Address - Street 1:9715 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 501
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3320
Practice Address - Country:US
Practice Address - Phone:301-738-0300
Practice Address - Fax:301-738-1316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG00562Medicare PIN