Healthcare Provider Details

I. General information

NPI: 1043314214
Provider Name (Legal Business Name): HERMON W SMITH III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E EAGER STREET
BALTIMORE MD
21202
US

IV. Provider business mailing address

3100 WYMAN PARK DRIVE SUITE 359A
BALTIMORE MD
21211
US

V. Phone/Fax

Practice location:
  • Phone: 410-522-9800
  • Fax: 410-522-9872
Mailing address:
  • Phone: 410-338-3016
  • Fax: 410-338-3420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD36633
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: