Provider Demographics
NPI:1417013749
Name:SMITH, JEAN WHEELER (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:WHEELER
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:JEAN
Other - Middle Name:SMITH
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9400 SURRATTS RD
Mailing Address - Street 2:
Mailing Address - City:CHELTENHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20623
Mailing Address - Country:US
Mailing Address - Phone:301-372-1800
Mailing Address - Fax:301-372-1906
Practice Address - Street 1:9400 SURRATTS RD
Practice Address - Street 2:
Practice Address - City:CHELTENHAM
Practice Address - State:MD
Practice Address - Zip Code:20623
Practice Address - Country:US
Practice Address - Phone:301-372-1800
Practice Address - Fax:301-372-1906
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDOO308952084P0800X
DCMD132082084P0800X
VA01010385462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD55698Medicaid
MD55698Medicaid
E23700Medicare UPIN