Provider Demographics
NPI:1902188832
Name:SMITH, DELMAR J (PA)
Entity Type:Individual
Prefix:
First Name:DELMAR
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1197 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-2236
Mailing Address - Country:US
Mailing Address - Phone:917-698-1017
Mailing Address - Fax:
Practice Address - Street 1:2900 WHIPPLE AVE STE 132
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062
Practice Address - Country:US
Practice Address - Phone:650-306-1016
Practice Address - Fax:650-369-3627
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY23 014300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant