Healthcare Provider Details

I. General information

NPI: 1427378595
Provider Name (Legal Business Name): JONATHAN ST. PIERRE SMITH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8505 ARLINGTON BLVD STE 200
FAIRFAX VA
22031-4630
US

IV. Provider business mailing address

1306 CONCOURSE DR STE 201
LINTHICUM HEIGHTS MD
21090-1033
US

V. Phone/Fax

Practice location:
  • Phone: 301-564-3131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0102203164
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number0102203164
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: