Provider Demographics
NPI:1376921148
Name:SPECTRUM CENTER FOR NATURAL MEDICINE
Entity Type:Organization
Organization Name:SPECTRUM CENTER FOR NATURAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN FOSSAN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, MAC
Authorized Official - Phone:301-565-2700
Mailing Address - Street 1:8555 16TH ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-2816
Mailing Address - Country:US
Mailing Address - Phone:301-565-2700
Mailing Address - Fax:
Practice Address - Street 1:8555 16TH ST
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-2816
Practice Address - Country:US
Practice Address - Phone:301-565-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01225171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty