Provider Demographics
NPI:1205837069
Name:SMITH, CHRISTOPHER J (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-341-0288
Mailing Address - Fax:859-341-7482
Practice Address - Street 1:85 NORTH GRAND AVENUE
Practice Address - Street 2:
Practice Address - City:FT. THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-1793
Practice Address - Country:US
Practice Address - Phone:859-912-7211
Practice Address - Fax:859-655-6674
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41585174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0829072Medicaid
KY7100044490Medicaid
OH000000008876OtherANTHEM
000000560926OtherANTHEM
OH0420604OtherUNITED HEALTH CARE
OH634925OtherAETNA
KYP00922874OtherRAIL ROAD MEDICARE
KY0399023Medicare PIN
OHE76653Medicare UPIN
000000560926OtherANTHEM
KY7100044490Medicaid
OHSM0686242Medicare PIN
OH0420604OtherUNITED HEALTH CARE
KYP00601165Medicare PIN