Healthcare Provider Details

I. General information

NPI: 1023127669
Provider Name (Legal Business Name): SMITA N VAZARKAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4924 CAMPBELL BLVD STE 200
NOTTINGHAM MD
21236
US

IV. Provider business mailing address

9910 FRANKLIN SQUARE DR # 2110
BALTIMORE MD
21236-4902
US

V. Phone/Fax

Practice location:
  • Phone: 443-442-2300
  • Fax:
Mailing address:
  • Phone: 410-933-5412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD50721
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: