1205812013 NPI number — STEVEN R SMITH M.D.

Table of content: STEVEN R SMITH M.D. (NPI 1205812013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205812013 NPI number — STEVEN R SMITH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
STEVEN
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205812013
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1671
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUMBERLAND
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21501-1671
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-964-8342
Provider Business Mailing Address Fax Number:
240-964-8337

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 SETON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUMBERLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21502-1854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-723-1443
Provider Business Practice Location Address Fax Number:
301-723-1480
Provider Enumeration Date:
12/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  D18216 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: BLUE CHOICE . This is a "J697 001" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: P00135060 . This is a "TRAVELERS MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1840787000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 615935 01 . This is a "CAREFIRST BC BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 718200700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 615935 02 . This is a "CAREFIRST BC BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com