Provider Demographics
NPI:1356462261
Name:SMEARMAN, MARK CHARLES (PT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:CHARLES
Last Name:SMEARMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 YARMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-7838
Mailing Address - Country:US
Mailing Address - Phone:410-823-0653
Mailing Address - Fax:443-460-4003
Practice Address - Street 1:341 N CALVERT ST STE 300
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3654
Practice Address - Country:US
Practice Address - Phone:410-576-9777
Practice Address - Fax:410-547-8323
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15357225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD780-3294OtherAETNA PPO
MDS484-0001OtherCAREFIRST
MD337-6245OtherAETNA HMO
MD719M262FMedicare ID - Type Unspecified