Active NPI
Givonshy Smith
- Dermatopathology Physician
- Upper Marlboro, MD
National Provider Identifier
1710450408
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatopathology Physician
- License
- 419974
- Practice address
- 10478 Campus Way S # 185
Upper Marlboro, MD 20774-1304 - Phone
- (240) 883-6080
- NPI assigned
- Jan 6, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatopathology Physician | 207ND0900X | 419974 | MD | Primary |
| Dermatology Physician | 207N00000X | 419974 | MD |
Addresses
Primary practice location
10478 Campus Way S # 185
Upper Marlboro, MD 20774-1304
Mailing address
10478 Campus Way S Ste 185
Upper Marlboro, MD 20774-1304
Phone (240) 883-6080
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 419974 | MD | MD | Dermatopathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1546732800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1546732800000",
"number": "1710450408",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10478 CAMPUS WAY S STE 185",
"city": "UPPER MARLBORO",
"state": "MD",
"postal_code": "207741304",
"telephone_number": "240-883-6080"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10478 CAMPUS WAY S # 185",
"city": "UPPER MARLBORO",
"state": "MD",
"postal_code": "207741304",
"telephone_number": "240-883-6080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "GIVONSHY",
"name_prefix": "Miss",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-01-06",
"last_updated": "2019-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "207ND0900X",
"taxonomy_group": "",
"desc": "Dermatology, Dermatopathology",
"state": "MD",
"license": "419974",
"primary": true
},
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "MD",
"license": "419974",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Upper Marlboro, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.