Provider Demographics
NPI:1760183594
Name:SMITH, OREN REGINALD
Entity Type:Individual
Prefix:
First Name:OREN
Middle Name:REGINALD
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4915 AYERS PL SE APT 101
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-6276
Mailing Address - Country:US
Mailing Address - Phone:240-762-3952
Mailing Address - Fax:
Practice Address - Street 1:2041 MLK JR. AVE SE
Practice Address - Street 2:200
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020
Practice Address - Country:US
Practice Address - Phone:202-717-9323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-17
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator