Individual
COREY DIXON SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPRS
Contact information
Practice address
14 S BROADWAY, BALTIMORE, MD 21231-1712
(410) 276-1773
(410) 276-2056
Mailing address
14 S BROADWAY, BALTIMORE, MD 21231-1712
(410) 276-1773
(410) 276-2056
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
PR0591
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PR0591
CPRS
MD
Enumeration date
11/02/2022
Last updated
11/02/2022
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