Provider Demographics
NPI:1831411933
Name:SMITH-CHAKMAKOVA, FAYE M (MD)
Entity type:Individual
Prefix:DR
First Name:FAYE
Middle Name:M
Last Name:SMITH-CHAKMAKOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FAYE
Other - Middle Name:MARIE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4TH AND WALNUT
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-1281
Mailing Address - Country:US
Mailing Address - Phone:717-720-7551
Mailing Address - Fax:717-272-4931
Practice Address - Street 1:2170 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7026
Practice Address - Country:US
Practice Address - Phone:530-541-3420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC165898207ZP0102X
PAMD447815207ZP0102X
AZR71376207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR71376OtherTRAINING PERMIT
PAP01392613OtherRAILROAD MEDICARE
PA102944900Medicaid
PA360557JA7Medicare PIN