Provider Demographics
NPI:1841276490
Name:SMITH, ANDREW C (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6096 E MAIN ST STE 112
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-4302
Mailing Address - Country:US
Mailing Address - Phone:614-755-3000
Mailing Address - Fax:614-755-4052
Practice Address - Street 1:6096 E MAIN ST STE 112
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-4302
Practice Address - Country:US
Practice Address - Phone:614-755-3000
Practice Address - Fax:614-755-4052
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-3745207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0477336Medicaid
OH4011781Medicare PIN
OHB96533Medicare UPIN