Provider Demographics
NPI:1396741492
Name:SMITH, ELLIOT L (MD)
Entity type:Individual
Prefix:
First Name:ELLIOT
Middle Name:L
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 1:217 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EVANS CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16033-1219
Mailing Address - Country:US
Mailing Address - Phone:724-538-9700
Mailing Address - Fax:724-538-9710
Practice Address - Street 1:217 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EVANS CITY
Practice Address - State:PA
Practice Address - Zip Code:16033-1219
Practice Address - Country:US
Practice Address - Phone:724-538-9700
Practice Address - Fax:724-538-9710
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053373L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001530960 0008Medicaid
PAP00232506OtherRR MED INDIV #
PA001530960 0008Medicaid
PA783370ECTMedicare PIN