Provider Demographics
NPI:1902038029
Name:MARK V SMITH MD PLLC
Entity Type:Organization
Organization Name:MARK V SMITH MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:VOGEL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-724-4763
Mailing Address - Street 1:PO BOX 4218
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13504-4218
Mailing Address - Country:US
Mailing Address - Phone:315-724-4763
Mailing Address - Fax:206-984-1260
Practice Address - Street 1:441 BROWN RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:NY
Practice Address - Zip Code:13340-4303
Practice Address - Country:US
Practice Address - Phone:315-724-4763
Practice Address - Fax:206-984-1260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178548-1207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty