Provider Demographics
NPI:1689976235
Name:SMITH, WESTLEY MARK (MD)
Entity Type:Individual
Prefix:MR
First Name:WESTLEY
Middle Name:MARK
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:
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Mailing Address - Street 1:2924 SWEDE RD
Mailing Address - Street 2:
Mailing Address - City:E. NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19401-1336
Mailing Address - Country:US
Mailing Address - Phone:484-370-8140
Mailing Address - Fax:484-370-8135
Practice Address - Street 1:2924 SWEDE RD
Practice Address - Street 2:
Practice Address - City:E. NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19401-1336
Practice Address - Country:US
Practice Address - Phone:484-370-8140
Practice Address - Fax:484-370-8135
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD4653592086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1035607910001Medicaid