Provider Demographics
NPI:1700852308
Name:VAULX-SMITH, PETRONILLA M (MD)
Entity Type:Individual
Prefix:DR
First Name:PETRONILLA
Middle Name:M
Last Name:VAULX-SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 FORBES AVE
Mailing Address - Street 2:OXFORD BUILDING ROOM 661
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3317
Mailing Address - Country:US
Mailing Address - Phone:412-246-5804
Mailing Address - Fax:
Practice Address - Street 1:3501 FORBES AVE
Practice Address - Street 2:OXFORD BUILDING ROOM 661
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3317
Practice Address - Country:US
Practice Address - Phone:412-246-5804
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045072L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF53939Medicare UPIN
PA739921F3FMedicare ID - Type Unspecified