Provider Demographics
NPI:1568442929
Name:SMITH, MICHELLE A (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 ARCOLA RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-3954
Mailing Address - Country:US
Mailing Address - Phone:484-565-8440
Mailing Address - Fax:610-409-6160
Practice Address - Street 1:599 ARCOLA RD
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426
Practice Address - Country:US
Practice Address - Phone:484-565-8440
Practice Address - Fax:610-409-6160
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043847E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01623595Medicaid
PA620588Medicare ID - Type Unspecified
PA01623595Medicaid