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General NPI Number Information
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NPI Number | 1528135829
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Entity Type | Individual
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Provider Name | RICHARD DALE SMITH PA
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Gender | Male
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 11/14/2007
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Provider Practice Location Address
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Address Line | 5755 CEDAR LANE SUITE 134 HOWARD COUNTY GENERAL HOSPITAL EMERGENCY ROOM
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City | COLUMBIA
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State | MD
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Zip | 21044
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Country | US
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Telephone | 410-884-4746
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Fax | 410-884-4749
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Provider Business Mailing Address
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Address Line | 205 BURNS CROSSING ROAD
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City | SEVERN
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State | MD
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Zip | 21144-3408
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Country | US
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Telephone | 410-305-0348
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C0001979
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License Number State | MD
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