Provider Demographics
NPI:1225370570
Name:SMITH, AMENA (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:AMENA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:AMENA
Other - Middle Name:WESTON
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD PHD
Mailing Address - Street 1:400 E LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-2542
Mailing Address - Country:US
Mailing Address - Phone:706-829-7170
Mailing Address - Fax:
Practice Address - Street 1:KENNEDY KRIEGER INSTITUTE
Practice Address - Street 2:707 N BROADWAY
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205
Practice Address - Country:US
Practice Address - Phone:443-923-2750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00822202080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities