Provider Demographics
NPI:1508805367
Name:ALVA D SMITH MD PC
Entity Type:Organization
Organization Name:ALVA D SMITH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALVA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-759-5491
Mailing Address - Street 1:751 E 16TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-2321
Mailing Address - Country:US
Mailing Address - Phone:570-759-5491
Mailing Address - Fax:570-759-5495
Practice Address - Street 1:751 E 16TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-2321
Practice Address - Country:US
Practice Address - Phone:570-759-5491
Practice Address - Fax:570-759-5495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1379115OtherPA BLUE SHIELD
PA0019024200002Medicaid
PA0019024200002Medicaid