Provider Demographics
NPI:1922087345
Name:SMITH, MICHAEL ROBERT (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROBERT
Last Name:SMITH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HAMPTON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-4848
Mailing Address - Country:US
Mailing Address - Phone:603-775-7575
Mailing Address - Fax:603-778-9680
Practice Address - Street 1:1 HAMPTON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-4848
Practice Address - Country:US
Practice Address - Phone:603-775-7575
Practice Address - Fax:603-778-9680
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0417363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30333019Medicaid
T400147070Medicare PIN
NH30333019Medicaid
NH5469460001Medicare NSC
NHAP165901Medicare PIN