Provider Demographics
NPI:1871633107
Name:SMITH, RENEE (PA)
Entity Type:Individual
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First Name:RENEE
Middle Name:
Last Name:SMITH
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Gender:F
Credentials:PA
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Mailing Address - Street 1:207 N BROAD ST
Mailing Address - Street 2:3RD FLR CARDIOLOGY CONSULTANTS OF PHILA PC
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:215-462-7100
Mailing Address - Fax:215-463-3820
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:POB I SUITE 400
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-3902
Practice Address - Country:US
Practice Address - Phone:610-876-2400
Practice Address - Fax:610-876-4308
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2017-02-20
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Provider Licenses
StateLicense IDTaxonomies
PAMA001153L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103198302 0001Medicaid
PA103198302 0001Medicaid