Healthcare Provider Details

I. General information

NPI: 1982063194
Provider Name (Legal Business Name): JERE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5606 SHIELDS DR
BETHESDA MD
20817-3571
US

IV. Provider business mailing address

412 1ST ST SE LOWER LEVEL REAR ENTRANCE
WASHINGTON DC
20003-1804
US

V. Phone/Fax

Practice location:
  • Phone: 301-493-0023
  • Fax:
Mailing address:
  • Phone: 202-470-4185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: