Provider Demographics
NPI:1487627238
Name:SMITH, HENRY KYLE (DO)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:KYLE
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:945 E PARK DR
Mailing Address - Street 2:STE 102
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-2804
Mailing Address - Country:US
Mailing Address - Phone:717-561-4940
Mailing Address - Fax:717-561-4999
Practice Address - Street 1:10413 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-6065
Practice Address - Country:US
Practice Address - Phone:717-561-4940
Practice Address - Fax:717-561-4999
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05002617L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0628327Medicaid
PA0628327Medicaid
PASM149240Medicare ID - Type Unspecified