Provider Demographics
NPI:1639517147
Name:SMITH, CHRISTOPHER LACEY (MD , PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:LACEY
Last Name:SMITH
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Gender:M
Credentials:MD , PHD
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Mailing Address - Street 1:100 E PENN SQ FL 9
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3377
Mailing Address - Country:US
Mailing Address - Phone:215-590-1000
Mailing Address - Fax:215-590-2768
Practice Address - Street 1:3401 CIVIC CENTER BLVD
Practice Address - Street 2:9NW63
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4319
Practice Address - Country:US
Practice Address - Phone:215-590-1220
Practice Address - Fax:215-590-2768
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2021-10-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD4588182080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1034955680001Medicaid