1336156587 NPI number — PROF. PATRICIA R SMITH CRNP/PMH

Table of content: PROF. PATRICIA R SMITH CRNP/PMH (NPI 1336156587)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336156587 NPI number — PROF. PATRICIA R SMITH CRNP/PMH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
PATRICIA
Provider Middle Name:
R
Provider Name Prefix Text:
PROF.
Provider Name Suffix Text:
Provider Credential Text:
CRNP/PMH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PILOTTI
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336156587
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5158 ORCHARD GRN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21045-1930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-825-2281
Provider Business Mailing Address Fax Number:
410-825-0757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1407 YORK RD
Provider Second Line Business Practice Location Address:
SUITE 309
Provider Business Practice Location Address City Name:
LUTHERVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21093-6097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-825-2281
Provider Business Practice Location Address Fax Number:
410-825-0757
Provider Enumeration Date:
08/01/2006

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: 363L00000X , with the licence number:  R39655 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363LP0808X , with the licence number: R39655 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 361LE325 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: N57763 . This is a "CDS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 010736J69 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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