1932520301 NPI number — SARINA RENE SMITH BS

Table of content: LAURA K KONDRAT FNP-BC (NPI 1205114758)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932520301 NPI number — SARINA RENE SMITH BS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
SARINA
Provider Middle Name:
RENE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LONG
Provider Other First Name:
SARINA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932520301
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1113 HEALTHWAY DR
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:
21804-4470
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-334-6961
Provider Business Mailing Address Fax Number:
410-334-6362

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11120 SOMERSET AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCESS ANNE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21853-2970
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-651-4200
Provider Business Practice Location Address Fax Number:
410-651-4290
Provider Enumeration Date:
01/02/2014

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 609500300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 609500303 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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