Provider Demographics
NPI:1831130517
Name:SMITH, PAUL H JR (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:H
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:645 N 12TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1219
Mailing Address - Country:US
Mailing Address - Phone:717-763-7037
Mailing Address - Fax:717-763-8093
Practice Address - Street 1:645 N 12TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1219
Practice Address - Country:US
Practice Address - Phone:717-763-7037
Practice Address - Fax:717-763-8093
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD038446E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE61960Medicare UPIN
PA533758Medicare ID - Type Unspecified