Provider Demographics
NPI:1750360418
Name:SMITH, REGINA W (DO)
Entity type:Individual
Prefix:DR
First Name:REGINA
Middle Name:W
Last Name:SMITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1000 BENT CREEK BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-1869
Mailing Address - Country:US
Mailing Address - Phone:717-766-0651
Mailing Address - Fax:717-766-0654
Practice Address - Street 1:310 LAMBS GAP RD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-2522
Practice Address - Country:US
Practice Address - Phone:717-795-9566
Practice Address - Fax:717-795-9567
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS010770L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018443900004Medicaid
PADB9443OtherRAILROAD MEDICARE
PAH36047Medicare UPIN
PA71450Medicare ID - Type Unspecified