Provider Demographics
NPI:1295736742
Name:SMITH, ERIC D (DO)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:D
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:255 EAST GROVE STREET
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-1628
Mailing Address - Country:US
Mailing Address - Phone:570-209-7878
Mailing Address - Fax:570-209-7715
Practice Address - Street 1:255 EAST GROVE STREET
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1628
Practice Address - Country:US
Practice Address - Phone:570-209-7878
Practice Address - Fax:570-209-7715
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS 012156207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA002709OtherFIRST PRIORITY
PAI14983Medicare UPIN
PA326180Medicare UPIN