Provider Demographics
NPI:1083634406
Name:SMITH, KINDRA RENEE (MD)
Entity Type:Individual
Prefix:
First Name:KINDRA
Middle Name:RENEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 YORKTOWN PLZ
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1424
Mailing Address - Country:US
Mailing Address - Phone:215-600-4590
Mailing Address - Fax:
Practice Address - Street 1:1000 WHITE HORSE RD STE 202
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4408
Practice Address - Country:US
Practice Address - Phone:856-644-6428
Practice Address - Fax:856-344-9096
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061546207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD406123300Medicaid
MD132190100Medicaid
MD406123300Medicaid
MD211819Medicare Oscar/Certification
MDI20937Medicare UPIN
MDJ932Medicare PIN