Provider Demographics
NPI:1700889078
Name:SMOOT-HASELNUS, CATHERINE NORREYS (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:NORREYS
Last Name:SMOOT-HASELNUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 PINE BLUFF RD
Mailing Address - Street 2:STE 1
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-7199
Mailing Address - Country:US
Mailing Address - Phone:410-749-1191
Mailing Address - Fax:410-749-3319
Practice Address - Street 1:105 PINE BLUFF RD
Practice Address - Street 2:STE 1
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-7199
Practice Address - Country:US
Practice Address - Phone:410-749-1191
Practice Address - Fax:410-749-3319
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD38571207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE42057Medicare UPIN
MD240L359BMedicare ID - Type Unspecified