Provider Demographics
NPI:1922099357
Name:SMITLEY, ROBERT E (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:SMITLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1260 MONROE ST NW
Mailing Address - Street 2:STE 1A
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-4147
Mailing Address - Country:US
Mailing Address - Phone:440-743-2121
Mailing Address - Fax:440-743-2122
Practice Address - Street 1:6115 POWERS BLVD
Practice Address - Street 2:STE 204
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5471
Practice Address - Country:US
Practice Address - Phone:440-743-2121
Practice Address - Fax:440-743-2122
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH340063572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2019961Medicaid
OH2019961Medicaid
G49512Medicare UPIN