Provider Demographics
NPI:1720086358
Name:SMITH, MARK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-5120
Mailing Address - Fax:717-741-3075
Practice Address - Street 1:2350 FREEDOM WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8200
Practice Address - Country:US
Practice Address - Phone:717-812-5120
Practice Address - Fax:717-741-3075
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042036E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30089001OtherAMERIHEALTH MERCY-WMG
PA416568OtherUPMC-WMG
PA01983901OtherCAPITAL BLUE CROSS
PA1000010194OtherRAILROAD MEDICARE
PA0015159270001Medicaid
PA627382OtherHIGHMARK BLUE SHIELD
PA1523749OtherGATEWAY-WMG
MD973501OtherCAREFIRST MD BCBS-WMG
PA627382Medicare PIN
PA627382OtherHIGHMARK BLUE SHIELD
F99632Medicare UPIN
PAP00932644Medicare PIN