Provider Demographics
NPI:1043408115
Name:SMOLKO, BETH RENEE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:RENEE
Last Name:SMOLKO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:BETH
Other - Middle Name:RENEE
Other - Last Name:WIESER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:70 THOMAS JOHNSON DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702
Mailing Address - Country:US
Mailing Address - Phone:301-668-9393
Mailing Address - Fax:301-668-4480
Practice Address - Street 1:70 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 101
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4361
Practice Address - Country:US
Practice Address - Phone:301-668-9393
Practice Address - Fax:301-668-4480
Is Sole Proprietor?:No
Enumeration Date:2007-10-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003661363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant