Provider Demographics
NPI:1922079383
Name:SMITH, GRAIG W (MD)
Entity Type:Individual
Prefix:DR
First Name:GRAIG
Middle Name:W
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4685 FOREST AVE
Mailing Address - Street 2:STE C
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3359
Mailing Address - Country:US
Mailing Address - Phone:513-559-9411
Mailing Address - Fax:513-559-0419
Practice Address - Street 1:3219 CLIFTON AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-3027
Practice Address - Country:US
Practice Address - Phone:513-559-9411
Practice Address - Fax:513-559-0419
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2017-07-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35053318S207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0641621Medicaid
OHSM0592874OtherPTAN
OHSM0592874OtherPTAN
OHA16733Medicare UPIN
OH0641621Medicaid
OH0592872Medicare PIN