Provider Demographics
NPI:1780033852
Name:SMITH, BENJAMIN RUSSELL (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:RUSSELL
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:AMERICA BUILDING (#19) 4TH FLOOR 4954 NORTH PALMER ROAD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-0001
Mailing Address - Country:US
Mailing Address - Phone:301-400-1663
Mailing Address - Fax:301-400-1662
Practice Address - Street 1:AMERICA BUILDING (#19) 4TH FLOOR 4954 NORTH PALMER ROAD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5001
Practice Address - Country:US
Practice Address - Phone:301-400-1663
Practice Address - Fax:301-400-1662
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE30220208D00000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN