Healthcare Provider Details

I. General information

NPI: 1902031081
Provider Name (Legal Business Name): KEVIN LEE SMOTHERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 LOCUST LANE, SUITE 301 ACCESS CARROLL, INC.
WESTMINSTER MD
21157
US

IV. Provider business mailing address

200 MEMORIAL AVE CARROLL HOSPITAL CENTER
WESTMINSTER MD
21157
US

V. Phone/Fax

Practice location:
  • Phone: 410-871-1478
  • Fax: 410-871-3219
Mailing address:
  • Phone: 410-987-6010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0055791
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: