Basic Information
| Provider Information | |||||||||
| NPI: | 1255311239 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMOLOSKI | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1602 NEWPORT GAP PIKE | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198086208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026335840 | ||||||||
| FaxNumber: | 3026335844 | ||||||||
| Practice Location | |||||||||
| Address1: | 609B DUTCHMANS LN | ||||||||
| Address2: | |||||||||
| City: | EASTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216013345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107708865 | ||||||||
| FaxNumber: | 4107708869 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | D0057859 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | KER4RO | 01 | MD | BCBS - MD - TRAD | OTHER | G878-0001 | 01 | MD | BCBS - MD - FED | OTHER |