1558672006 NPI number — JOAN SMITH, D.O. P.A.

Table of content: (NPI 1558672006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558672006 NPI number — JOAN SMITH, D.O. P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOAN SMITH, D.O. P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1558672006
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31664 OLD OCEAN CITY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21804-1800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-334-3805
Provider Business Mailing Address Fax Number:
410-860-5191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31664 OLD OCEAN CITY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21804-1800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-334-3805
Provider Business Practice Location Address Fax Number:
410-860-5191
Provider Enumeration Date:
06/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
JOAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
410-334-3805

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  H0048286 , 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: 669500100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 916Q . This is a "MEDICARE, PTAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com