Provider Demographics
NPI:1518193747
Name:SMERNOFF-O'DONNELL, JAN (MED)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:SMERNOFF-O'DONNELL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 WARDEN RD
Mailing Address - Street 2:
Mailing Address - City:BARNET
Mailing Address - State:VT
Mailing Address - Zip Code:05821-9318
Mailing Address - Country:US
Mailing Address - Phone:802-633-3930
Mailing Address - Fax:
Practice Address - Street 1:389 WARDEN RD
Practice Address - Street 2:
Practice Address - City:BARNET
Practice Address - State:VT
Practice Address - Zip Code:05821-9318
Practice Address - Country:US
Practice Address - Phone:802-633-3930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VTEARLY SPED174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist