Provider Demographics
NPI:1497856678
Name:SMALLS, NORMA M (MD)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:M
Last Name:SMALLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14705 KENT DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-7792
Mailing Address - Country:US
Mailing Address - Phone:301-785-1923
Mailing Address - Fax:301-952-8501
Practice Address - Street 1:HOWARD UNIVERSITY HOSPITAL 2041 GEORGIA AVE NW
Practice Address - Street 2:DEPARTMENT OF SURGERY 4 TH FLOOR
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060-0001
Practice Address - Country:US
Practice Address - Phone:240-374-0007
Practice Address - Fax:301-952-8501
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD11619208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD220741900Medicaid
DCG00900OtherMEDICARE PTAN
DC027563800Medicaid
MDC89185Medicare UPIN
MD00B206N00Medicare PIN