1013008267 NPI number — NORMA M SMALLS-MANTEY MD PC

Table of content: (NPI 1013008267)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013008267 NPI number — NORMA M SMALLS-MANTEY MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORMA M SMALLS-MANTEY MD PC
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:
6
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:
1013008267
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14705 KENT DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UPPER MARLBORO
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20772
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-373-0003
Provider Business Mailing Address Fax Number:
301-952-8501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HOWARD UNIVERSITY HOSPITAL
Provider Second Line Business Practice Location Address:
2041 GEORGIA AVE NW DEPARTMENT OF SURGERY
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20060-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-373-0003
Provider Business Practice Location Address Fax Number:
301-952-8501
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMALLS
Authorized Official First Name:
NORMA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
240-373-0003

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 027563800 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".




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