Provider Demographics
NPI:1699097246
Name:SMITH, REGINALD ORLANDA (BSN,RN, MBA,JD)
Entity type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:ORLANDA
Last Name:SMITH
Suffix:
Gender:M
Credentials:BSN,RN, MBA,JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15705 MAHOGANY CIR APT 103
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-4646
Mailing Address - Country:US
Mailing Address - Phone:240-453-6081
Mailing Address - Fax:
Practice Address - Street 1:15705 MAHOGANY CIR APT 103
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-4646
Practice Address - Country:US
Practice Address - Phone:240-453-6081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR 0082409163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care