Provider Demographics
NPI:1235579905
Name:SMITH, CORY ANDREW (DO)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:ANDREW
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-7985
Mailing Address - Country:US
Mailing Address - Phone:304-366-2600
Mailing Address - Fax:304-366-2080
Practice Address - Street 1:700 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-7985
Practice Address - Country:US
Practice Address - Phone:304-366-2600
Practice Address - Fax:304-366-2080
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT015463207R00000X
WV30012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine