Provider Demographics
NPI:1124010608
Name:SMITH, ALVA D (MD)
Entity Type:Individual
Prefix:DR
First Name:ALVA
Middle Name:D
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALVA
Other - Middle Name:D
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:751 E 16TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-2321
Mailing Address - Country:US
Mailing Address - Phone:570-759-5491
Mailing Address - Fax:570-759-3723
Practice Address - Street 1:751 E 16TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-2321
Practice Address - Country:US
Practice Address - Phone:570-759-5491
Practice Address - Fax:570-759-3723
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056490L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA681149D3BMedicare PIN
PAF81109Medicare UPIN