Provider Demographics
NPI:1689601163
Name:SMITH, CORWIN M (MD)
Entity Type:Individual
Prefix:DR
First Name:CORWIN
Middle Name:M
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 1:1945 CEI DRIVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-3311
Mailing Address - Country:US
Mailing Address - Phone:513-984-5133
Mailing Address - Fax:513-569-3941
Practice Address - Street 1:1945 CEI DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-5664
Practice Address - Country:US
Practice Address - Phone:513-984-5133
Practice Address - Fax:513-569-3941
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0170363Medicaid
KY64786338Medicaid
000000020499OtherBCBS
OH0170363Medicaid
KY64786338Medicaid