Provider Demographics
NPI:1073786307
Name:SMITH, DREW M
Entity Type:Individual
Prefix:MR
First Name:DREW
Middle Name:M
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9809 RHODE ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-1423
Mailing Address - Country:US
Mailing Address - Phone:301-220-1930
Mailing Address - Fax:301-220-1906
Practice Address - Street 1:9809 RHODE ISLAND AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-1423
Practice Address - Country:US
Practice Address - Phone:301-220-1930
Practice Address - Fax:301-220-1906
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM02492171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM02492OtherLICENSE