Provider Demographics
NPI:1710913736
Name:SMITH, STAFFORD MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:STAFFORD
Middle Name:MICHAEL
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:102 N ABINGTON RD
Mailing Address - Street 2:SUITE #103
Mailing Address - City:CLARKS GREEN
Mailing Address - State:PA
Mailing Address - Zip Code:18411-2300
Mailing Address - Country:US
Mailing Address - Phone:570-586-0246
Mailing Address - Fax:570-585-8970
Practice Address - Street 1:102 N ABINGTON RD
Practice Address - Street 2:SUITE #103
Practice Address - City:CLARKS GREEN
Practice Address - State:PA
Practice Address - Zip Code:18411-2300
Practice Address - Country:US
Practice Address - Phone:570-586-0246
Practice Address - Fax:570-585-8970
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD040434L207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF22556Medicare UPIN
PASMS 713870VB5Medicare ID - Type Unspecified