Healthcare Provider Details

I. General information

NPI: 1891984985
Provider Name (Legal Business Name): FREDERICK P SMITH, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5454 WISCONSIN AVE SUITE 1300
CHEVY CHASE MD
20815-6901
US

IV. Provider business mailing address

5454 WISCONSIN AVE SUITE 1300
CHEVY CHASE MD
20815-6901
US

V. Phone/Fax

Practice location:
  • Phone: 301-657-4588
  • Fax: 301-657-9565
Mailing address:
  • Phone: 240-644-1233
  • Fax: 301-657-9565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFERY M BANNER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: CPA
Phone: 240-644-1256