Provider Demographics
NPI:1285835264
Name:STEPHEN A. SMITH, M.D., P.C.
Entity Type:Organization
Organization Name:STEPHEN A. SMITH, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENT DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-369-8780
Mailing Address - Street 1:54 BAKER AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2189
Mailing Address - Country:US
Mailing Address - Phone:978-369-8780
Mailing Address - Fax:978-369-1043
Practice Address - Street 1:54 BAKER AVENUE
Practice Address - Street 2:SUITE 303
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2189
Practice Address - Country:US
Practice Address - Phone:978-369-8780
Practice Address - Fax:978-369-1043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA34311174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB72575Medicare UPIN