Provider Demographics
NPI:1922519370
Name:SMITH, ERIC (HIS)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1917
Mailing Address - Country:US
Mailing Address - Phone:717-877-9241
Mailing Address - Fax:
Practice Address - Street 1:1915 HOLLY ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17104-1917
Practice Address - Country:US
Practice Address - Phone:717-877-9241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-12
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF03421237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA$$$$$$$$$OtherSOCIAL SECURITY