Basic Information
| Provider Information | |||||||||
| NPI: | 1326239575 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | NANNA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3299 WOODBURN RD | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | ANNANDALE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220031275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032601179 | ||||||||
| FaxNumber: | 7032601179 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 MEDICAL PKWY | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214013742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105739530 | ||||||||
| FaxNumber: | 4105739569 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2007 | ||||||||
| LastUpdateDate: | 05/14/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | D0070737 | MD | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VC0200X | D0070737 | MD | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Critical Care Medicine | 207V00000X | 0101252905 | VA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.