Provider Demographics
NPI:1801064969
Name:SMITH, ANDREA DAWN (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:DAWN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21800 MARKET PL NW STE 103
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-6667
Mailing Address - Country:US
Mailing Address - Phone:360-291-5700
Mailing Address - Fax:360-291-5702
Practice Address - Street 1:21800 MARKET PL NW STE 103
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6667
Practice Address - Country:US
Practice Address - Phone:360-291-5700
Practice Address - Fax:360-637-0863
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60650348207ND0101X, 207NS0135X, 207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2078206Medicaid