Provider Demographics
NPI:1790770626
Name:SMITH, BYRON D (MD)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:D
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:
Other - Credentials:
Mailing Address - Street 1:73 WEST MAIN ST
Mailing Address - Street 2:PO BOX 110
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-8853
Mailing Address - Country:US
Mailing Address - Phone:740-774-3023
Mailing Address - Fax:740-774-3043
Practice Address - Street 1:272 HOSPITAL RD
Practice Address - Street 2:ADENA REGIONAL MEDICAL CENTER
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-8853
Practice Address - Country:US
Practice Address - Phone:740-779-7657
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044605207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0548287Medicaid
C03593Medicare UPIN
SM0534565Medicare ID - Type Unspecified