Provider Demographics
NPI:1083899611
Name:SMITH, HAROLD ALVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:ALVIN
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-1433
Mailing Address - Country:US
Mailing Address - Phone:570-387-9494
Mailing Address - Fax:570-387-9495
Practice Address - Street 1:127 NORTH ST
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-1433
Practice Address - Country:US
Practice Address - Phone:570-387-9494
Practice Address - Fax:570-387-9495
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 018623 E208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice