Provider Demographics
NPI:1144339649
Name:MEDSMITH MEDICAL PC
Entity type:Organization
Organization Name:MEDSMITH MEDICAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-394-8170
Mailing Address - Street 1:241 PARRISH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1727
Mailing Address - Country:US
Mailing Address - Phone:585-394-8170
Mailing Address - Fax:585-394-8173
Practice Address - Street 1:241 PARRISH ST
Practice Address - Street 2:SUITE B
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1727
Practice Address - Country:US
Practice Address - Phone:585-394-8170
Practice Address - Fax:585-394-8173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224291207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0769Medicare ID - Type UnspecifiedGROUP MEDICARE NO.