Provider Demographics
NPI:1114987625
Name:SMALLING, DAVID B (RPA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:B
Last Name:SMALLING
Suffix:
Gender:M
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 FOOTE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6947
Mailing Address - Country:US
Mailing Address - Phone:716-338-9200
Mailing Address - Fax:716-338-9250
Practice Address - Street 1:117 FOOTE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6947
Practice Address - Country:US
Practice Address - Phone:716-338-9200
Practice Address - Fax:716-338-9250
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009394363AM0700X, 208800000X, 363A00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No208800000XAllopathic & Osteopathic PhysiciansUrology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
117209FZOtherPREFERRED CARE
9512418OtherINDEPENDENT HEALTH
P019009394OtherBLUE CHOICE
000570446003OtherCOMMUNITY BLUE
NY02504727Medicaid
NYP00387380OtherRAILROAD MEDICARE
00026702202OtherUNIVERA
NYP00387380OtherRAILROAD MEDICARE
NY02504727Medicaid