Provider Demographics
NPI:1285821181
Name:CHERYL E. SMITH, M.D., P.C.
Entity Type:Organization
Organization Name:CHERYL E. SMITH, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:EVETTE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-881-0665
Mailing Address - Street 1:15 HIGH ST E
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-2595
Mailing Address - Country:US
Mailing Address - Phone:856-881-0665
Mailing Address - Fax:856-881-1449
Practice Address - Street 1:15 HIGH ST E
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-2595
Practice Address - Country:US
Practice Address - Phone:856-881-0665
Practice Address - Fax:856-881-1449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04238400207ZD0900X, 207ZH0000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Single Specialty
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2392704Medicaid
NJ35552OtherAETNA
NJ010835000OtherAMERIHEALTH
NJ35552OtherAETNA
NJD19221Medicare UPIN
PA484434Medicare PIN