Provider Demographics
NPI:1821610981
Name:SMITH, IAN RUTHERFORD (MD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:RUTHERFORD
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 1:507 HOBBY HORSE HL
Mailing Address - Street 2:
Mailing Address - City:LOWER GWYNEDD
Mailing Address - State:PA
Mailing Address - Zip Code:19002-1313
Mailing Address - Country:US
Mailing Address - Phone:267-970-2165
Mailing Address - Fax:
Practice Address - Street 1:555 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2250
Practice Address - Country:US
Practice Address - Phone:717-544-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT219947207P00000X
PAMD480854207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine