Healthcare Provider Details

I. General information

NPI: 1174309447
Provider Name (Legal Business Name): THOMAS SMOOT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2023
Last Update Date: 09/04/2023
Certification Date: 09/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W 7TH ST
FREDERICK MD
21701-4506
US

IV. Provider business mailing address

2874 SUMMIT POINT RD
SUMMIT POINT WV
25446-3595
US

V. Phone/Fax

Practice location:
  • Phone: 240-566-3250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number25909
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: