Provider Demographics
NPI:1467770883
Name:SMITH, MONICA
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 WELLNESS WAY
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-9706
Mailing Address - Country:US
Mailing Address - Phone:725-225-3640
Mailing Address - Fax:
Practice Address - Street 1:5535 PLATT SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-7519
Practice Address - Country:US
Practice Address - Phone:803-314-9510
Practice Address - Fax:803-314-9511
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS016774207V00000X
SC91461207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology