Provider Demographics
NPI:1063416881
Name:SMITH, KATHERINE J DONEBY (PA-C)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:J DONEBY
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:702 RUSSELL AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2606
Mailing Address - Country:US
Mailing Address - Phone:301-355-7037
Mailing Address - Fax:301-355-7501
Practice Address - Street 1:702 RUSSELL AVE
Practice Address - Street 2:STE 100
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2606
Practice Address - Country:US
Practice Address - Phone:301-355-7037
Practice Address - Fax:301-355-7501
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0000639363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD151651500Medicaid
MD093081400Medicaid
MD093081400Medicaid
DC639913Medicare ID - Type UnspecifiedGROUP NUMBER
110039674Medicare ID - Type UnspecifiedMEDICARE RAILROAD GRP NO.