Provider Demographics
NPI:1639183254
Name:SMITH, CHARLES STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:STEVEN
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 1:1009B DUPONT SQUARE NORTH
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4612
Mailing Address - Country:US
Mailing Address - Phone:502-895-3330
Mailing Address - Fax:502-898-3356
Practice Address - Street 1:1009B DUPONT SQUARE NORTH
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4612
Practice Address - Country:US
Practice Address - Phone:502-895-3330
Practice Address - Fax:502-898-3356
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17390207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY030004050OtherRAILROAD MEDICARE
C71883Medicare UPIN
KY7339Medicare PIN
KY030004050OtherRAILROAD MEDICARE