Provider Demographics
NPI:1114965530
Name:ROBERT J. SMOLOSKI, M.D., P.A.
Entity Type:Organization
Organization Name:ROBERT J. SMOLOSKI, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SMOLOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-770-8865
Mailing Address - Street 1:609 DUTCHMANS LN STE B
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3348
Mailing Address - Country:US
Mailing Address - Phone:410-770-8865
Mailing Address - Fax:410-770-8865
Practice Address - Street 1:609B DUTCHMANS LN
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3345
Practice Address - Country:US
Practice Address - Phone:410-770-8865
Practice Address - Fax:410-770-8869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057859207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG878-0001OtherBCBS - MD - FED
MDKER4ROOtherBCBS - MD - TRAD
MDG82961Medicare UPIN
MDG878-0001OtherBCBS - MD - FED