Provider Demographics
NPI:1093824500
Name:GARCIA, LORI SMITH (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:SMITH
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LORI
Other - Middle Name:ALLEYNE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2117 COLONEL WAY
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1004
Mailing Address - Country:US
Mailing Address - Phone:410-672-3786
Mailing Address - Fax:
Practice Address - Street 1:900 S CATON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5201
Practice Address - Country:US
Practice Address - Phone:410-368-2011
Practice Address - Fax:410-368-3502
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00535702080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD421901500Medicaid