Provider Demographics
NPI:1548601123
Name:SMITH, MARTHA JOHANNA
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:JOHANNA
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 G ST SE APT 613
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-7019
Mailing Address - Country:US
Mailing Address - Phone:301-652-4344
Mailing Address - Fax:
Practice Address - Street 1:4915 SAINT ELMO AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-6019
Practice Address - Country:US
Practice Address - Phone:301-652-4344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
DCHHA6197374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide