Basic Information
| Provider Information | |||||||||
| NPI: | 1376528265 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SPECTOR | ||||||||
| FirstName: | MICHELLE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11850 W MARKET PL | ||||||||
| Address2: | SUITE P | ||||||||
| City: | FULTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207592670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013408339 | ||||||||
| FaxNumber: | 2404855407 | ||||||||
| Practice Location | |||||||||
| Address1: | 9711 MEDICAL CENTER DR | ||||||||
| Address2: | STE 109 | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208503323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017625501 | ||||||||
| FaxNumber: | 3013098727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2005 | ||||||||
| LastUpdateDate: | 05/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | D0058868 | MD | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 402734500 | 05 | MD | MEDICAID |