Provider Demographics
NPI:1043340441
Name:E. SMITH SURGICAL ASSOCIATE INC
Entity Type:Organization
Organization Name:E. SMITH SURGICAL ASSOCIATE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:ADEMOLA
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-612-4700
Mailing Address - Street 1:3998 RED LION RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1441
Mailing Address - Country:US
Mailing Address - Phone:215-612-2652
Mailing Address - Fax:
Practice Address - Street 1:261 MEETING HOUSE LN
Practice Address - Street 2:
Practice Address - City:MERION STATION
Practice Address - State:PA
Practice Address - Zip Code:19066-1231
Practice Address - Country:US
Practice Address - Phone:610-771-0290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 066013-L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30027672OtherKEYSTONE MERCY
PW36420MD066013LOtherHEALTH PARTNERS
PASM1821064OtherHIGH MARK BLUE SHIELD
PA0764657000OtherKEYSTON HP EAST
PA1147631OtherAETNA
PASM1821064OtherHIGH MARK BLUE SHIELD