Provider Demographics
NPI:1811975733
Name:SMADJA-GORDON, MICHELE R (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:R
Last Name:SMADJA-GORDON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:116 DEFENSE HWY
Mailing Address - Street 2:STE 400
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7027
Mailing Address - Country:US
Mailing Address - Phone:410-897-9841
Mailing Address - Fax:410-897-9852
Practice Address - Street 1:116 DEFENSE HWY
Practice Address - Street 2:STE 400
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7027
Practice Address - Country:US
Practice Address - Phone:410-897-9841
Practice Address - Fax:410-897-9852
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2010-07-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD31998207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
E10428Medicare UPIN
646L224DMedicare ID - Type Unspecified