Basic Information
| Provider Information | |||||||||
| NPI: | 1992761779 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KASHYAP | ||||||||
| FirstName: | SMRITI | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7670 QUARTERFIELD RD | ||||||||
| Address2: | |||||||||
| City: | GLEN BURNIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210613947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105087650 | ||||||||
| FaxNumber: | 4105087732 | ||||||||
| Practice Location | |||||||||
| Address1: | 7670 QUARTERFIELD RD | ||||||||
| Address2: | |||||||||
| City: | GLEN BURNIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210613947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105087650 | ||||||||
| FaxNumber: | 4105087732 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 06/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 2288861 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 02439421 | 05 | NY | MEDICAID |