Provider Demographics
NPI:1821076548
Name:SMITH, ANDREW THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:THOMAS
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 1:525 IRON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-1949
Mailing Address - Country:US
Mailing Address - Phone:610-826-5052
Mailing Address - Fax:610-681-3468
Practice Address - Street 1:525 IRON ST
Practice Address - Street 2:SUITE B
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-1949
Practice Address - Country:US
Practice Address - Phone:610-826-5052
Practice Address - Fax:610-681-3468
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06618600174400000X
PAMD042636L174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017730280001Medicaid
NJ020043562OtherRAILROAD MEDICARE
NJ223676672OtherAETNA
PA020043562OtherRAILROAD MEDICARE
PA2163726OtherAETNA USHC
NJ7350104Medicaid
NJ1085642OtherHORIZON NJ HEALTH
NJ1522199OtherGATEWAY HEALTHPLAN
PA223676672OtherAETNA
PA959505OtherBLUE CROSS/SHEILD
NJ223676672OtherDEVON
NJ223676672OtherBEECHSTREET
NJ2163626OtherAETNA USHC
PA223676672OtherBEECHSTREET
NJ223676672OtherCONSUMER HEALTH NETWORK
NJ223676672OtherBEECHSTREET
PAG60096Medicare UPIN
NJ2163626OtherAETNA USHC