Provider Demographics
NPI:1851326060
Name:SMALARA, DOUGLAS M (MD)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:M
Last Name:SMALARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1401 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-3313
Mailing Address - Country:US
Mailing Address - Phone:859-655-6100
Mailing Address - Fax:859-655-6148
Practice Address - Street 1:120 PROGRESS WAY
Practice Address - Street 2:
Practice Address - City:OWENTON
Practice Address - State:KY
Practice Address - Zip Code:40359-1502
Practice Address - Country:US
Practice Address - Phone:844-655-6100
Practice Address - Fax:502-484-2102
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY35027207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64041403Medicaid
KYH51178Medicare UPIN
KY64041403Medicaid
H51178Medicare UPIN