Provider Demographics
NPI:1205812013
Name:SMITH, STEVEN R (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:SMITH
Suffix:
Gender:M
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:PO BOX 1671
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21501-1671
Mailing Address - Country:US
Mailing Address - Phone:240-964-8342
Mailing Address - Fax:240-964-8337
Practice Address - Street 1:900 SETON DR
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1854
Practice Address - Country:US
Practice Address - Phone:301-723-1443
Practice Address - Fax:301-723-1480
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD18216207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCBLUE CHOICEOtherJ697 001
MDP00135060OtherTRAVELERS MEDICARE
WV1840787000Medicaid
MD615935 01OtherCAREFIRST BC BS
MD718200700Medicaid
MD615935 02OtherCAREFIRST BC BS
MDI734Medicare PIN