MEDICARE: DEREK JENKINS SMITH

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	374U00000X	Home Health Aide
2	171M00000X	Case Manager/Care Coordinator
3	3747P1801X	Personal Care Attendant	DC

General Provider Information

NPI Number	:	1407496110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREK JENKINS SMITH

Provider Business Mailing Address
First Line	:	5711 BELRIDGE RD
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-3627
Country	:	US
Telephone Number	:	240-821-0234
Fax Number	:

Provider Business Practice Location Address
First Line	:	2811 PENNSYLVANIA AVE SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-3865
Country	:	US
Telephone Number	:	202-894-6811
Fax Number	:

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

Provider Enumeration Date	:	01/10/2020
Last Update Date	:	01/09/2026

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Directions to “ DEREK JENKINS SMITH ” Practice Location

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