Healthcare Provider Details

I. General information

NPI: 1699095158
Provider Name (Legal Business Name): THOMAS GILLESPIE SMITH MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 06/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3102 FLORAL PARK RD
CLINTON MD
20735-9665
US

IV. Provider business mailing address

4105 HOLLY TREE RD
TEMPLE HILLS MD
20748-6709
US

V. Phone/Fax

Practice location:
  • Phone: 301-292-2778
  • Fax: 301-292-0275
Mailing address:
  • Phone: 301-423-3790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: