Provider Demographics
NPI:1740241686
Name:SMITH, ROBERT PAUL (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:PAUL
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 1:4002 PENNYFIELDS LOCK CT
Mailing Address - Street 2:
Mailing Address - City:POINT OF ROCKS
Mailing Address - State:MD
Mailing Address - Zip Code:21777-2083
Mailing Address - Country:US
Mailing Address - Phone:216-496-4686
Mailing Address - Fax:
Practice Address - Street 1:4002 PENNYFIELDS LOCK CT
Practice Address - Street 2:
Practice Address - City:POINT OF ROCKS
Practice Address - State:MD
Practice Address - Zip Code:21777-2083
Practice Address - Country:US
Practice Address - Phone:216-496-4686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053661S207P00000X
PAMD459087207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103163503Medicaid
OH0677316Medicaid
OH1740241686OtherMEDICARE NPI
OH1740241686OtherMEDICARE NPI
OH0677316Medicaid