Provider Demographics
NPI:1578581815
Name:SMITH, EDWARD H (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:H
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:130 MOUNT AUBURN ST
Mailing Address - Street 2:#301
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5757
Mailing Address - Country:US
Mailing Address - Phone:617-497-2640
Mailing Address - Fax:617-779-6343
Practice Address - Street 1:736 CAMBRIDGE ST
Practice Address - Street 2:RADIOLOGY CMP 4
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2907
Practice Address - Country:US
Practice Address - Phone:617-789-2740
Practice Address - Fax:617-779-6343
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA323972085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2036401Medicaid
B75933Medicare UPIN
MAM09011Medicare ID - Type Unspecified