Provider Demographics
NPI:1083753156
Name:SPENCER, ELIOT (CRNA, MSN)
Entity type:Individual
Prefix:MR
First Name:ELIOT
Middle Name:
Last Name:SPENCER
Suffix:
Gender:M
Credentials:CRNA, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6955 COUNTRY CLUB TER
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:MD
Mailing Address - Zip Code:21774-6717
Mailing Address - Country:US
Mailing Address - Phone:240-772-0578
Mailing Address - Fax:
Practice Address - Street 1:8901 WISCONSIN AVE WRNMMC
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0001
Practice Address - Country:US
Practice Address - Phone:013-295-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC83256163W00000X
MDR210739367500000X
SC4390367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse