Provider Demographics
NPI:1013049618
Name:SMITH, LANA JOAN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LANA
Middle Name:JOAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10111 MAPLE LEAF DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-1117
Mailing Address - Country:US
Mailing Address - Phone:240-631-0139
Mailing Address - Fax:
Practice Address - Street 1:981 RUSSELL AVE
Practice Address - Street 2:JAMES MATTHEWS, M.D.
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-6219
Practice Address - Country:US
Practice Address - Phone:301-216-2065
Practice Address - Fax:301-216-2065
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0001876363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQ15273Medicare UPIN
MD014105D80Medicare ID - Type UnspecifiedPROVIDER NUMBER