Provider Demographics
NPI:1447306121
Name:SMYTH, SHAWN F (MD)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:F
Last Name:SMYTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2411 W BELVEDERE AVE
Mailing Address - Street 2:#202
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5228
Mailing Address - Country:US
Mailing Address - Phone:410-367-7600
Mailing Address - Fax:410-367-7666
Practice Address - Street 1:5051 GREENSPRING AVE STE 200
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-4357
Practice Address - Country:US
Practice Address - Phone:410-367-7060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD716312084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD546500100Medicaid
MD546500100Medicaid