MEDICARE: STAR SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant		DC

General Provider Information

NPI Number	:	1003561861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STAR SMITH

Provider Business Mailing Address
First Line	:	4222 4TH ST SE APT 101
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20032-3300
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4510 3RD ST SE APT A
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20032-3123
Country	:	US
Telephone Number	:	202-894-1797
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2022
Last Update Date	:	02/19/2022

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Directions to “ STAR SMITH ” Practice Location

Language	Start Address	Practice Location

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