Provider Demographics
NPI:1205190436
Name:SMITH, KYLE A (MD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5454 WISCONSIN AVE STE 1100
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6925
Mailing Address - Country:US
Mailing Address - Phone:301-215-4460
Mailing Address - Fax:301-215-4499
Practice Address - Street 1:5454 WISCONSIN AVE STE 1100
Practice Address - Street 2:SUITE 200
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6925
Practice Address - Country:US
Practice Address - Phone:301-215-4460
Practice Address - Fax:301-215-4499
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0080285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine