Provider Demographics
NPI:1003097569
Name:PETER C SMITH DPM
Entity Type:Organization
Organization Name:PETER C SMITH DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:717-560-4310
Mailing Address - Street 1:300 GRANITE RUN DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6806
Mailing Address - Country:US
Mailing Address - Phone:717-560-4310
Mailing Address - Fax:717-560-3452
Practice Address - Street 1:300 GRANITE RUN DR
Practice Address - Street 2:SUITE 160
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6806
Practice Address - Country:US
Practice Address - Phone:717-560-4310
Practice Address - Fax:717-560-3452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003298L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014543670002Medicaid
U43624Medicare UPIN
PA0014543670002Medicaid
538035Medicare PIN