Provider Demographics
NPI:1770796310
Name:SMITH, MONICA L (LMT)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1262 WOOD LN
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1769
Mailing Address - Country:US
Mailing Address - Phone:215-750-8830
Mailing Address - Fax:215-750-8840
Practice Address - Street 1:1262 WOOD LN
Practice Address - Street 2:STE. 104
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1769
Practice Address - Country:US
Practice Address - Phone:215-750-8830
Practice Address - Fax:215-750-8840
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG002857174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist