Healthcare Provider Details

I. General information

NPI: 1972855245
Provider Name (Legal Business Name): LAURYN R. SMITH-WINTON DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 SAINT PATRICKS DR STE 101
WALDORF MD
20603-5533
US

IV. Provider business mailing address

PO BOX 879
ACCOKEEK MD
20607-0879
US

V. Phone/Fax

Practice location:
  • Phone: 240-303-2901
  • Fax: 240-599-1993
Mailing address:
  • Phone: 240-303-2901
  • Fax: 240-599-1993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0103301118
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00327300
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number01687
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: