Provider Demographics
NPI:1891854188
Name:DRS STEVE & KELLIE SMALDORE FAMILY PRACTICE, INC
Entity Type:Organization
Organization Name:DRS STEVE & KELLIE SMALDORE FAMILY PRACTICE, INC
Other - Org Name:DRS STEVE & KELLIE MDVIP PRACTICE, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:BOBBITT
Authorized Official - Last Name:SMALDORE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:443-371-4940
Mailing Address - Street 1:2227 OLD EMMORTON RD STE 218
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6189
Mailing Address - Country:US
Mailing Address - Phone:433-371-4940
Mailing Address - Fax:443-371-4941
Practice Address - Street 1:2227 OLD EMMORTON RD STE 218
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6189
Practice Address - Country:US
Practice Address - Phone:443-371-4940
Practice Address - Fax:443-371-4941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD952110100Medicaid