Provider Demographics
NPI:1417128380
Name:SMITH, ALEXIS MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ALEXIS
Other - Middle Name:SMITH
Other - Last Name:SHIVELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1420 CENTRE AVE APT 1910
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219-3527
Mailing Address - Country:US
Mailing Address - Phone:215-869-2134
Mailing Address - Fax:
Practice Address - Street 1:7177 STRUTHERS RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44514-2270
Practice Address - Country:US
Practice Address - Phone:215-869-2134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS0166192085R0202X
OH34.0114342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology