MEDICARE: DR. KENNETH RONALD SMOTHERS M.D.

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	2084P0800X	Psychiatry Physician	MD10849	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0334	OTHER	DC	CAREFIRST BLUECROSS

General Provider Information

NPI Number	:	1326160680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH RONALD SMOTHERS M.D.

Provider Business Mailing Address
First Line	:	3801 CONNECTICUT AVE NW
Second Line	:	100-C
City	:	WASHINGTON
State	:	DC
Zip	:	20008-4530
Country	:	US
Telephone Number	:	202-364-0035
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 CONNECTICUT AVE NW
Second Line	:	100-C
City	:	WASHINGTON
State	:	DC
Zip	:	20008-4530
Country	:	US
Telephone Number	:	202-364-0035
Fax Number	:

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

Provider Enumeration Date	:	04/05/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. KENNETH RONALD SMOTHERS M.D.” Practice Location

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