Provider Demographics
NPI:1790162493
Name:SMITH, LATANGELA RENEE (DO)
Entity Type:Individual
Prefix:DR
First Name:LATANGELA
Middle Name:RENEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1463 FINNEGAN LN # E
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-5025
Mailing Address - Country:US
Mailing Address - Phone:803-270-9499
Mailing Address - Fax:
Practice Address - Street 1:1463 FINNEGAN LN # E
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-5025
Practice Address - Country:US
Practice Address - Phone:803-270-9499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361677012084N0400X
WI81362-212084N0400X
IN02007583A2084N0400X
TN54952084N0400X
LA3399212084N0400X
VA01022056262084N0400X
NC2020-018682084N0400X
NJ25MA120573002084N0400X
FLOS206282084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology