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General NPI Number Information
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NPI Number | 1013049618
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Entity Type | Individual
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Provider Name | LANA JOAN SMITH PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 981 RUSSELL AVE JAMES MATTHEWS, M.D.
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City | GAITHERSBURG
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State | MD
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Zip | 20879-6219
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Country | US
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Telephone | 301-216-2065
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Fax | 301-216-2065
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Provider Business Mailing Address
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Address Line | 10111 MAPLE LEAF DR
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City | MONTGOMERY VILLAGE
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State | MD
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Zip | 20886-1117
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Country | US
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Telephone | 240-631-0139
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | C0001876
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License Number State | MD
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