Organization
GLADYS REA SMITH
Active
Other names
Lady M Mastectomy Boutique
Organization subpart
No
Provider details
NPI number
Authorized official
GLADYS SMITH (OWNER)
(703) 461-7534
Entity
Organization
Contact information
Practice address
50 S PICKETT ST, SUITE 210, ALEXANDRIA, VA 22304-7207
(703) 461-7534
Mailing address
50 S PICKETT ST, SUITE 210, ALEXANDRIA, VA 22304-7207
(703) 461-7534
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
C18127
MD
Other
Enumeration date
01/08/2008
Last updated
07/03/2008
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