Healthcare Provider Details

I. General information

NPI: 1558672006
Provider Name (Legal Business Name): JOAN SMITH, D.O. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31664 OLD OCEAN CITY RD
SALISBURY MD
21804-1800
US

IV. Provider business mailing address

31664 OLD OCEAN CITY RD
SALISBURY MD
21804-1800
US

V. Phone/Fax

Practice location:
  • Phone: 410-334-3805
  • Fax: 410-860-5191
Mailing address:
  • Phone: 410-334-3805
  • Fax: 410-860-5191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberH0048286
License Number StateMD

VIII. Authorized Official

Name: JOAN SMITH
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 410-334-3805