Provider Demographics
NPI:1457328551
Name:SMITH, TALBOT LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:TALBOT
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 BIGLERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-8019
Mailing Address - Country:US
Mailing Address - Phone:717-334-8165
Mailing Address - Fax:717-338-9070
Practice Address - Street 1:1311 BIGLERVILLE RD
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-8019
Practice Address - Country:US
Practice Address - Phone:717-334-8165
Practice Address - Fax:717-338-9070
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424762207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD424762OtherMEDICAL LICENSE
I39369Medicare UPIN
PAMD424762OtherMEDICAL LICENSE