Provider Demographics
NPI:1114120961
Name:SMITH, RYAN T (DO)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:T
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:RYAN
Other - Middle Name:T
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:863 NAZARETH PIKE
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-9001
Practice Address - Country:US
Practice Address - Phone:484-373-3260
Practice Address - Fax:484-373-3128
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013608207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine