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NPI Code Detail

MEDICARE: MR. SAMUEL BERNARD SMITH JR.

MEDICARE: MR. SAMUEL BERNARD SMITH JR.
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
13747P1801XPersonal Care Attendant

General Provider Information

NPI Number : 1588502116
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SAMUEL BERNARD SMITH JR.
Provider Business Mailing Address
First Line : 3813 COPPERVILLE WAY
Second Line :
City : FORT WASHINGTON
State : MD
Zip : 20744-1087
Country : US
Telephone Number : 227-220-7627
Fax Number :
Provider Business Practice Location Address
First Line : 4660 MARTIN LUTHER KING JR AVE SW APT B606
Second Line :
City : WASHINGTON
State : DC
Zip : 20032-4980
Country : US
Telephone Number : 202-421-3065
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2026
Last Update Date : 03/24/2026

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