Provider Demographics
NPI:1255768172
Name:SMITH, BRIAN (BOCPO)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:BOCPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 MILFORD ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-7099
Mailing Address - Country:US
Mailing Address - Phone:443-859-8754
Mailing Address - Fax:443-859-8966
Practice Address - Street 1:209 MILFORD ST
Practice Address - Street 2:SUITE C
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-7099
Practice Address - Country:US
Practice Address - Phone:443-859-8754
Practice Address - Fax:443-859-8966
Is Sole Proprietor?:No
Enumeration Date:2013-10-09
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC22040222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE6524730001Medicare NSC