Provider Demographics
NPI:1013008267
Name:NORMA M SMALLS-MANTEY MD PC
Entity Type:Organization
Organization Name:NORMA M SMALLS-MANTEY MD PC
Other - Org Name:NORMA SMALLS MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMALLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-373-0003
Mailing Address - Street 1:14705 KENT DRIVE
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772
Mailing Address - Country:US
Mailing Address - Phone:240-373-0003
Mailing Address - Fax:301-952-8501
Practice Address - Street 1:HOWARD UNIVERSITY HOSPITAL
Practice Address - Street 2:2041 GEORGIA AVE NW DEPARTMENT OF SURGERY
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060-0001
Practice Address - Country:US
Practice Address - Phone:240-373-0003
Practice Address - Fax:301-952-8501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC027563800Medicaid
C89185Medicare UPIN
DC027563800Medicaid