Provider Demographics
NPI:1487180691
Name:SMITH, MARY PAT
Entity Type:Individual
Prefix:
First Name:MARY PAT
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 PHILMONT AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-5306
Mailing Address - Country:US
Mailing Address - Phone:215-244-9130
Mailing Address - Fax:215-244-9133
Practice Address - Street 1:2600 PHILMONT AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-5306
Practice Address - Country:US
Practice Address - Phone:215-244-9130
Practice Address - Fax:215-244-9133
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-08
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA233096884332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies