Provider Demographics
NPI:1386655074
Name:SMITH, DENNIS MICHAEL (MD FCCP)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:MICHAEL
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD FCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 WILKENS AVE STE 440
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5073
Mailing Address - Country:US
Mailing Address - Phone:410-644-5112
Mailing Address - Fax:410-644-6517
Practice Address - Street 1:3407 WILKENS AVE STE 440
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5073
Practice Address - Country:US
Practice Address - Phone:410-644-5112
Practice Address - Fax:410-644-6517
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD22875207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD222511500Medicaid
MD222511500Medicaid
MDK039Medicare ID - Type Unspecified