Individual
MS. ELISE DIAZ SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.C.C.
Contact information
Practice address
22 S GREENE ST, BALTIMORE, MD 21201-1544
(410) 328-6897
(410) 328-2109
Mailing address
PO BOX 64693, BALTIMORE, MD 21264-4742
(410) 328-6897
(410) 328-2109
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
01078
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0017
CAREFIRST REGIONAL
MD
01
—
257288
KAISER
MD
01
—
3545
GEISINGER
MD
01
—
369745
MDIPA
MD
01
—
64648301
BLUE SHIELD
MD
Enumeration date
08/08/2006
Last updated
02/04/2008
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