Provider Demographics
NPI:1619909942
Name:SMITH, DAVID R (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:33 E CHESTNUT HILL AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-2713
Mailing Address - Country:US
Mailing Address - Phone:215-247-0900
Mailing Address - Fax:215-247-7696
Practice Address - Street 1:33 EAST CHESTNUT HILL AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19118
Practice Address - Country:US
Practice Address - Phone:215-247-0900
Practice Address - Fax:215-247-7696
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD041843L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006744190004Medicaid
PA701393Medicare PIN
E09065Medicare UPIN