MEDICARE: DR. MONIQUE SMITH DCN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist	DX5582	MD

General Provider Information

NPI Number	:	1093408825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONIQUE SMITH DCN

Provider Business Mailing Address
First Line	:	3106 RAMSGATE PL
Second Line	:
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-2157
Country	:	US
Telephone Number	:	240-506-2086
Fax Number	:

Provider Business Practice Location Address
First Line	:	3106 RAMSGATE PL
Second Line	:
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-2157
Country	:	US
Telephone Number	:	240-506-2086
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2023
Last Update Date	:	05/29/2023

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