Provider Demographics
NPI:1508823394
Name:SMITH, MARIA D (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:D
Other - Last Name:TORREDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1859 SW NEWLAND WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-6966
Mailing Address - Country:US
Mailing Address - Phone:386-758-0003
Mailing Address - Fax:386-755-4432
Practice Address - Street 1:1859 SW NEWLAND WAY
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-6966
Practice Address - Country:US
Practice Address - Phone:386-758-0003
Practice Address - Fax:386-755-4432
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0069118208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL44219OtherBCBS
593537428OtherPEDICARE
1635516001OtherCIGNA
593537428OtherPHCS
593537428OtherCHAMPUS/TRICARE
593537428OtherPCN
071674OtherVISTA HP
5575526OtherAETNA
593537428OtherUNITED HEALTHCARE
FL251174600Medicaid
277591OtherAVMED
593537428OtherFIRST HEALTH
593537428OtherCHAMPUS/TRICARE