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Mrs. Gretchen Lee Smith

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NPI Number Detailed Information

Provider Information:

Name: Mrs. Gretchen Lee Smith
Gender: F
Provider License Number If Given: C0002171

NPI Information:

NPI: 1619976149
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 7/18/2005

Last Update Date: 7/8/2007

Provider Business Mailing Address:

Address: 1650 UNION AVE PBG EMPLOYEE HEALTH & WELLNESS CENTER
Baltimore, MD 21211
Phone Number: 4105547874
Fax Number:

Provider Business Practice Location Address:

Address: 1650 UNION AVE PBG EMPLOYEE HEALTH & WELLNESS CENTER
Baltimore, MD 21211
Phone Number: 4105547874
Fax Number:

Provider Taxonomy:

Primary: 363A00000X
Secondary (if any):
State: MD

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