Provider Demographics
NPI:1922253277
Name:SMITHDEAL, CHARLES DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DAVID
Last Name:SMITHDEAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12050 4TH ST E
Mailing Address - Street 2:
Mailing Address - City:TREASURE ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33706-4426
Mailing Address - Country:US
Mailing Address - Phone:727-512-5131
Mailing Address - Fax:
Practice Address - Street 1:12050 4TH ST E
Practice Address - Street 2:
Practice Address - City:TREASURE ISLAND
Practice Address - State:FL
Practice Address - Zip Code:33706-4426
Practice Address - Country:US
Practice Address - Phone:727-512-5131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-27
Last Update Date:2008-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY085157207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology