Healthcare Provider Details

I. General information

NPI: 1811454978
Provider Name (Legal Business Name): MAGGIE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 O ST NW
WASHINGTON DC
20057-0002
US

IV. Provider business mailing address

202 STONELEDGE PL NE
LEESBURG VA
20176-4959
US

V. Phone/Fax

Practice location:
  • Phone: 202-687-6670
  • Fax:
Mailing address:
  • Phone: 703-999-6330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number003334
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: