Provider Demographics
NPI:1619966561
Name:SMITH, DAVID JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOSEPH
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 1:24 DOCTORS LANE
Mailing Address - Street 2:STE 200
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-8574
Mailing Address - Country:US
Mailing Address - Phone:814-226-1950
Mailing Address - Fax:814-226-1956
Practice Address - Street 1:24 DOCTORS LN STE 200
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-8574
Practice Address - Country:US
Practice Address - Phone:814-226-1950
Practice Address - Fax:814-226-1956
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036052288207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103514430Medicaid
IL036052288Medicaid
1620317OtherBCBS
ILK20313Medicare ID - Type Unspecified