Provider Demographics
NPI:1215431796
Name:SMITH, TAVIA KIA
Entity type:Individual
Prefix:
First Name:TAVIA
Middle Name:KIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6606 MARCH DR
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-2213
Mailing Address - Country:US
Mailing Address - Phone:240-593-3292
Mailing Address - Fax:
Practice Address - Street 1:6606 MARCH DR
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-2213
Practice Address - Country:US
Practice Address - Phone:240-593-3292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant