Provider Demographics
NPI:1447241997
Name:HERMAN-SMITH, REBECCA A (DO)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:HERMAN-SMITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:DESANTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:610 SOLAREX CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-8624
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:56 THOMAS JOHNSON DR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4599
Practice Address - Country:US
Practice Address - Phone:301-694-3111
Practice Address - Fax:301-694-8626
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0061791207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD926580503Medicaid
MD926580505Medicaid
MD926580505Medicaid
MD926580503Medicaid
MDCD8143Medicare PIN
MD451LMedicare PIN
MDP00377538Medicare PIN