Provider Demographics
NPI:1114950938
Name:SMA-DEER LAKES, P.C
Entity Type:Organization
Organization Name:SMA-DEER LAKES, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHISMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-767-5387
Mailing Address - Street 1:221 RUSSELLTON DORSEYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CHESWICK
Mailing Address - State:PA
Mailing Address - Zip Code:15024-2004
Mailing Address - Country:US
Mailing Address - Phone:412-767-5387
Mailing Address - Fax:412-767-5212
Practice Address - Street 1:221 RUSSELLTON DORSEYVILLE RD
Practice Address - Street 2:
Practice Address - City:CHESWICK
Practice Address - State:PA
Practice Address - Zip Code:15024-2004
Practice Address - Country:US
Practice Address - Phone:412-767-5387
Practice Address - Fax:412-767-5212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01680321Medicaid
PA004927Medicare PIN