Provider Demographics
NPI:1184722589
Name:SMYTH, ROBERT J (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:SMYTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2730 OBSERVATORY AVENUE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-2108
Mailing Address - Country:US
Mailing Address - Phone:513-321-2211
Mailing Address - Fax:513-321-0700
Practice Address - Street 1:2859 BOUDINOT AVENUE
Practice Address - Street 2:SUITE 302
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238
Practice Address - Country:US
Practice Address - Phone:513-244-2900
Practice Address - Fax:513-321-0700
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH37770207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH31-1080786OtherTAX ID #
OH0428531Medicaid
OH0428531Medicaid
OH31-1080786OtherTAX ID #