=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164406112
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANINE N. SMITH-MARSHALL M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2005
-----------------------------------------------------
Last Update Date | 03/31/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6915 LAUREL BOWIE RD SUITE 102
-----------------------------------------------------
City | BOWIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20715-1703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-464-7935
-----------------------------------------------------
Fax | 301-464-3762
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6915 LAUREL BOWIE RD STE 102
-----------------------------------------------------
City | BOWIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20715-1715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-464-7935
-----------------------------------------------------
Fax | 301-464-3762
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | D64175
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------