Provider Demographics
NPI:1467571257
Name:SMOLENSKI, MARK JANUSZ (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JANUSZ
Last Name:SMOLENSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JANUSZ
Other - Middle Name:MARK
Other - Last Name:SMOLENSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2500 HOSPITAL DR BLDG 1
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4106
Mailing Address - Country:US
Mailing Address - Phone:650-961-4900
Mailing Address - Fax:650-254-5500
Practice Address - Street 1:2500 HOSPITAL DR BLDG 1
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4106
Practice Address - Country:US
Practice Address - Phone:650-961-4900
Practice Address - Fax:650-254-5500
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-92552084P0800X
CAG724832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIF21058Medicare UPIN
CA00G724830Medicare ID - Type Unspecified
HIBFCCPMedicare ID - Type Unspecified
CAF21058Medicare UPIN