Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 0101041889 | VA |
N | 207PE0004X | Emergency Medical Services | 0101041889 | VA |
NPI | 1023045598 |
---|---|
Provider Name | Karl D Smith |
First Address | Germantown, MD 20876-7111 |
Second Address | Low Moor, VA 24457 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 20/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C60250 | (02) |