Provider Demographics
NPI:1922124452
Name:SMITH, ELLIECE SAUNDLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLIECE
Middle Name:SAUNDLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9470 ANNAPOLIS RD
Mailing Address - Street 2:SUITE 316
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3025
Mailing Address - Country:US
Mailing Address - Phone:301-459-5744
Mailing Address - Fax:301-459-5784
Practice Address - Street 1:9470 ANNAPOLIS RD
Practice Address - Street 2:SUITE 316
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3025
Practice Address - Country:US
Practice Address - Phone:301-459-5744
Practice Address - Fax:301-459-5784
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0021988207V00000X
DCMD10933207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCE52219Medicare UPIN
DC409396Medicare PIN