1497856678 NPI number — NORMA M SMALLS MD

Table of content: NORMA M SMALLS MD (NPI 1497856678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497856678 NPI number — NORMA M SMALLS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMALLS
Provider First Name:
NORMA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497856678
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14705 KENT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UPPER MARLBORO
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20772-7792
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-785-1923
Provider Business Mailing Address Fax Number:
301-952-8501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HOWARD UNIVERSITY HOSPITAL 2041 GEORGIA AVE NW
Provider Second Line Business Practice Location Address:
DEPARTMENT OF SURGERY 4 TH FLOOR
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20060-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-374-0007
Provider Business Practice Location Address Fax Number:
301-952-8501
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  MD11619 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 220741900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: G00900 . This is a "MEDICARE PTAN" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 027563800 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".




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