Provider Demographics
NPI:1134261407
Name:SMITH MEDICAL PC
Entity type:Organization
Organization Name:SMITH MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAASI
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-665-9225
Mailing Address - Street 1:PO BOX 21546
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-0546
Mailing Address - Country:US
Mailing Address - Phone:215-665-9225
Mailing Address - Fax:215-665-9242
Practice Address - Street 1:5201 WYNNEFIELD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-2456
Practice Address - Country:US
Practice Address - Phone:215-665-9225
Practice Address - Fax:215-665-9242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004747L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1427094259Medicare UPIN
PA5449660001Medicare NSC
PAU88971Medicare UPIN