Provider Demographics
NPI:1710690433
Name:CARLOS A. SMITH, M.D, PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CARLOS A. SMITH, M.D, PROFESSIONAL CORPORATION
Other - Org Name:DOCGO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NATIONAL DIRECTOR OF REVENUE SERVIC
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:BUCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:332-378-1616
Mailing Address - Street 1:35 W 35TH ST FL 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-2249
Mailing Address - Country:US
Mailing Address - Phone:844-553-6246
Mailing Address - Fax:977-282-9624
Practice Address - Street 1:197 BORDER AVENUE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501
Practice Address - Country:US
Practice Address - Phone:844-553-6246
Practice Address - Fax:977-282-9624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-27
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty