Provider Demographics
NPI:1497727242
Name:SMITH, MARK ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
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:PO BOX 6230
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-0722
Mailing Address - Country:US
Mailing Address - Phone:304-242-7106
Mailing Address - Fax:304-242-7108
Practice Address - Street 1:731 CANTON RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312
Practice Address - Country:US
Practice Address - Phone:330-784-2382
Practice Address - Fax:330-784-1312
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049167S207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0571117Medicaid
OHSM0559762Medicare ID - Type Unspecified
OH0571117Medicaid