Provider Demographics
NPI:1811973688
Name:SMOLEN, KATHERYN M (MD)
Entity type:Individual
Prefix:
First Name:KATHERYN
Middle Name:M
Last Name:SMOLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28276 KENSINGTON LN
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-4178
Mailing Address - Country:US
Mailing Address - Phone:419-843-4422
Mailing Address - Fax:
Practice Address - Street 1:28276 KENSINGTON LN
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-4178
Practice Address - Country:US
Practice Address - Phone:419-843-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.074631207RH0002X
OH35074631S207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000142295OtherANTHEM
OH110211982OtherRAILROAD MEDICARE
OH2113724Medicaid
OH03558OtherPARAMOUNT
OH2113724Medicaid
OH000000142295OtherANTHEM