Spencer Family Practice LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SPENCER FAMILY PRACTICE LLC

Practice address

8061 Springfield Rd
Glenn Dale, MD 20769-9605

Phone

(434) 390-6641

Fax

(240) 206-3855

NPI assigned

Jul 1, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Mary L Spencer, NPNPI 1073966735

Title

Ceo/ Owner

Phone

(434) 390-6641

Specialties & licenses 1

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mary Spencer, FNP

  • Family Nurse Practitioner
  • Glenn Dale, MD
  • NPI 1073966735
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1625097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625097600000",
    "number": "1568032464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8061 SPRINGFIELD RD",
            "city": "GLENN DALE",
            "state": "MD",
            "postal_code": "207699605",
            "telephone_number": "434-390-6641",
            "fax_number": "240-206-3855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8061 SPRINGFIELD RD",
            "city": "GLENN DALE",
            "state": "MD",
            "postal_code": "207699605",
            "telephone_number": "434-390-6641",
            "fax_number": "240-206-3855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPENCER FAMILY PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-01",
        "last_updated": "2021-07-01",
        "certification_date": "2021-06-25",
        "status": "A",
        "authorized_official_last_name": "SPENCER",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO/ OWNER",
        "authorized_official_telephone_number": "434-390-6641",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "225826900",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Octavia S Simkins-Wiseman, DDS
• Skinvana Medspa
• Smile HQ Mitchellville
• Lanita Marchel Smith
• Nicolas Smith
• Mary Spencer, FNP
• Sports Pro Physical Therapy LLC.
• Suburban Nephrology Associates LLC
• Success Is Yours Inc.
• Synergy Spine and Pain Center, LLC

• Family Medicine Physician in Glenn Dale, MD
• Providers in Glenn Dale, MD by specialty
• Family Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.