Provider Demographics
NPI:1013057827
Name:CATHERINE S SMITH MD LLC
Entity type:Organization
Organization Name:CATHERINE S SMITH MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD,FACOG,RDMS
Authorized Official - Phone:570-963-9474
Mailing Address - Street 1:401 ADAMS AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-2025
Mailing Address - Country:US
Mailing Address - Phone:570-963-9470
Mailing Address - Fax:570-963-9471
Practice Address - Street 1:401 ADAMS AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-2025
Practice Address - Country:US
Practice Address - Phone:570-963-9470
Practice Address - Fax:570-963-9471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037808E207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1426109OtherBLUE SHIELD PROVIDER NUMB
PA0011010440002Medicaid
NY161241OtherNY STATE MEDICAL LICENSE
PAMD037808EOtherPA MEDICAL LICENSE NUMBER
PAME04113831516OtherPA MEDICAL EDUCATION NUMB
PAMD037808EOtherPA MEDICAL LICENSE NUMBER
PAE79132Medicare UPIN