Healthcare Provider Details

I. General information

NPI: 1720170285
Provider Name (Legal Business Name): VERNON C SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 VARNUM ST NE SUITE # 211
WASHINGTON DC
20017-2107
US

IV. Provider business mailing address

PO BOX 42541
WASHINGTON DC
20015-0541
US

V. Phone/Fax

Practice location:
  • Phone: 202-726-8491
  • Fax: 202-726-4673
Mailing address:
  • Phone: 202-726-8491
  • Fax: 202-726-4673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD25805
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License NumberMD25805
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: