Provider Demographics
NPI:1558672006
Name:JOAN SMITH, D.O. P.A.
Entity type:Organization
Organization Name:JOAN SMITH, D.O. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:410-334-3805
Mailing Address - Street 1:31664 OLD OCEAN CITY RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-1800
Mailing Address - Country:US
Mailing Address - Phone:410-334-3805
Mailing Address - Fax:410-860-5191
Practice Address - Street 1:31664 OLD OCEAN CITY RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1800
Practice Address - Country:US
Practice Address - Phone:410-334-3805
Practice Address - Fax:410-860-5191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0048286261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD669500100Medicaid
MD916QOtherMEDICARE, PTAN
MDF68117Medicare UPIN