Provider Demographics
NPI:1710965934
Name:SMITH, CHARLOTTE H (MD)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:H
Last Name: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 1:2950 BUSKIRK AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-6900
Mailing Address - Country:US
Mailing Address - Phone:888-380-0988
Mailing Address - Fax:289-236-3022
Practice Address - Street 1:11490 GATEWAY BLVD N
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79934-3456
Practice Address - Country:US
Practice Address - Phone:888-380-0988
Practice Address - Fax:289-236-3022
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60279166208100000X
TXH24652081P0004X, 2081P0301X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine
No2081P0301XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationBrain Injury Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120282203Medicaid
115237100OtherFIRST CARE
742577636OtherTAX ID
00F89KOtherBCBS
00F89KMedicare ID - Type Unspecified
TX120282203Medicaid