Provider Demographics
NPI:1164406112
Name:SMITH-MARSHALL, JANINE N (MD)
Entity Type:Individual
Prefix:DR
First Name:JANINE
Middle Name:N
Last Name:SMITH-MARSHALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6915 LAUREL BOWIE RD
Mailing Address - Street 2:STE 102
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1715
Mailing Address - Country:US
Mailing Address - Phone:301-464-7935
Mailing Address - Fax:301-464-3762
Practice Address - Street 1:6915 LAUREL BOWIE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1703
Practice Address - Country:US
Practice Address - Phone:301-464-7935
Practice Address - Fax:301-464-3762
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD64175207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02312545Medicaid
NY426B01Medicare ID - Type Unspecified
DC149162ZDA6Medicare PIN
NYH49710Medicare UPIN