Provider Demographics
NPI:1457831166
Name:SMITH PODIATRY & ASSOCIATES LLC
Entity Type:Organization
Organization Name:SMITH PODIATRY & ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:443-386-6885
Mailing Address - Street 1:10999 RED RUN BLVD
Mailing Address - Street 2:STE 205 #179
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-1315
Mailing Address - Country:US
Mailing Address - Phone:410-357-1869
Mailing Address - Fax:410-927-8158
Practice Address - Street 1:5610 HARFORD RD STE A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214
Practice Address - Country:US
Practice Address - Phone:410-357-1869
Practice Address - Fax:410-927-8158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-21
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01466261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric