Provider Demographics
NPI:1154642197
Name:SMITH, CHARLOTTE JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:JANE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 DECATUR RD
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5741
Mailing Address - Country:US
Mailing Address - Phone:203-206-1541
Mailing Address - Fax:
Practice Address - Street 1:2146 BARTOW AVE SPC 280E
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4629
Practice Address - Country:US
Practice Address - Phone:646-346-7927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD455186207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA419731Medicare PIN