Healthcare Provider Details

I. General information

NPI: 1063952786
Provider Name (Legal Business Name): KIRSTIE DUCHARME-SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 S CHARLES ST APT 403
BALTIMORE MD
21230-4066
US

IV. Provider business mailing address

911 S CHARLES ST APT 403
BALTIMORE MD
21230-4066
US

V. Phone/Fax

Practice location:
  • Phone: 507-358-3454
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281PC2000X
TaxonomyChildren's Chronic Disease Hospital
License NumberDX3886
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: