Provider Demographics
NPI:1982663043
Name:SMITH, BERNARD HOWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:HOWARD
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 CRYSTAL LAKE RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-1713
Mailing Address - Country:US
Mailing Address - Phone:330-666-2862
Mailing Address - Fax:
Practice Address - Street 1:3809 DARROW RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-4035
Practice Address - Country:US
Practice Address - Phone:330-688-0639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1706207Q00000X, 207QA0505X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPIN 4478OtherPIN
310734478OtherTAX ID
OH0061150Medicaid
OH0061150Medicaid