Healthcare Provider Details

I. General information

NPI: 1114169414
Provider Name (Legal Business Name): SARA KATHRYN SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS ST # 2-116
BALTIMORE MD
21287-0010
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-8769
  • Fax: 410-367-2762
Mailing address:
  • Phone: 410-933-6423
  • Fax: 410-550-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberD93429
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: