Provider Demographics
NPI:1972855245
Name:SMITH-WINTON, LAURYN R (DPM)
Entity Type:Individual
Prefix:DR
First Name:LAURYN
Middle Name:R
Last Name:SMITH-WINTON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 MITCHELLVILLE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3953
Mailing Address - Country:US
Mailing Address - Phone:301-430-0337
Mailing Address - Fax:240-244-0617
Practice Address - Street 1:2905 MITCHELLVILLE RD STE 105
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3953
Practice Address - Country:US
Practice Address - Phone:301-430-0337
Practice Address - Fax:240-244-0617
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103301118213E00000X
NJ25MD00327300213ES0103X
MD01687213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVF376AMedicare PIN