Provider Demographics
NPI:1457342883
Name:SMITH, RICHARD STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:STEVEN
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 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:5170 STATE ROUTE 405
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:PA
Practice Address - Zip Code:17847-7510
Practice Address - Country:US
Practice Address - Phone:570-246-4575
Practice Address - Fax:570-246-4576
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201601185207R00000X
TN25644207R00000X
PAMD472167207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4221563OtherBLUE CROSS-BLUE SHIELD
TNP00760705OtherRR MEDICARE
TN3085788Medicaid
TNF21089Medicare UPIN
TN3085788Medicare ID - Type Unspecified
TN3085788Medicaid