Provider Demographics
NPI:1063432284
Name:SMITH, MARK JONATHAN (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:JONATHAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD, PHD
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Mailing Address - Street 1:729 13TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4437
Mailing Address - Country:US
Mailing Address - Phone:202-398-5575
Mailing Address - Fax:202-398-5575
Practice Address - Street 1:9021 SHADY GROVE CT
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1301
Practice Address - Country:US
Practice Address - Phone:301-590-9000
Practice Address - Fax:301-869-7760
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD00579692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry