Provider Demographics
NPI:1720170285
Name:SMITH, VERNON C (MD)
Entity Type:Individual
Prefix:DR
First Name:VERNON
Middle Name:C
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 42541
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-0541
Mailing Address - Country:US
Mailing Address - Phone:202-726-8491
Mailing Address - Fax:202-726-4673
Practice Address - Street 1:1160 VARNUM ST NE
Practice Address - Street 2:SUITE # 211
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2107
Practice Address - Country:US
Practice Address - Phone:202-726-8491
Practice Address - Fax:202-726-4673
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD25805207Q00000X, 207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1720170285OtherNPI
1720170285OtherNPI