Provider Demographics
NPI:1457611022
Name:BITSIMO-SMITH, CHARLIE F
Entity Type:Individual
Prefix:
First Name:CHARLIE
Middle Name:F
Last Name:BITSIMO-SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7006 HIGHVIEW TER APT 2
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-4030
Mailing Address - Country:US
Mailing Address - Phone:202-492-6820
Mailing Address - Fax:
Practice Address - Street 1:2759 MARTIN LUTHER KING JR AVE SE STE 105
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-2646
Practice Address - Country:US
Practice Address - Phone:202-563-8690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA1243374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCCHARLIE SMITH1Medicaid