Provider Demographics
NPI:1326160680
Name:SMOTHERS, KENNETH RONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:RONALD
Last Name:SMOTHERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 CONNECTICUT AVE NW
Mailing Address - Street 2:100-C
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-4530
Mailing Address - Country:US
Mailing Address - Phone:202-364-0035
Mailing Address - Fax:
Practice Address - Street 1:3801 CONNECTICUT AVE NW
Practice Address - Street 2:100-C
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-4530
Practice Address - Country:US
Practice Address - Phone:202-364-0035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD108492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0334OtherCAREFIRST BLUECROSS
DC0334OtherCAREFIRST BLUECROSS
DC158178Medicare ID - Type Unspecified