Provider Demographics
NPI:1891728689
Name:SMOLAR, ANDREW IAN (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:IAN
Last Name:SMOLAR
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 1:300 E LANCASTER AVE
Mailing Address - Street 2:#209
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096
Mailing Address - Country:US
Mailing Address - Phone:610-896-9360
Mailing Address - Fax:610-896-9370
Practice Address - Street 1:300 E LANCASTER AVE
Practice Address - Street 2:#209
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096
Practice Address - Country:US
Practice Address - Phone:610-896-9360
Practice Address - Fax:610-896-9370
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD047097L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E94841Medicare UPIN
PA070781Medicare ID - Type Unspecified