Provider Demographics
NPI:1245233840
Name:SMITH, JOAN (DO)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31664 OLD OCEAN CITY RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-1800
Mailing Address - Country:US
Mailing Address - Phone:410-334-3805
Mailing Address - Fax:410-860-5191
Practice Address - Street 1:31664 OLD OCEAN CITY RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1800
Practice Address - Country:US
Practice Address - Phone:410-334-3805
Practice Address - Fax:410-860-5191
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0048286207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD669500100Medicaid
MDF68117Medicare ID - Type Unspecified
MD669500100Medicaid