Healthcare Provider Details

I. General information

NPI: 1629114228
Provider Name (Legal Business Name): LORIE BENTON SMITH M.D., M.H.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORIE LEIGH BENTON-SMITH M.D.

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE NNMC, SECTION OF PEDIATRIC NEPHROLOGY
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

8901 WISCONSIN AVE HFM 486, SUITE 370 N
BETHESDA MD
20889-0004
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4941
  • Fax:
Mailing address:
  • Phone: 301-400-1769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberD70614
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: