Provider Demographics
NPI:1912964388
Name:SMYTH, MARY M (MD PC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:M
Last Name:SMYTH
Suffix:
Gender:F
Credentials:MD PC
Other - Prefix:
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Mailing Address - Street 1:535 FAUNCE CORNER RD
Mailing Address - Street 2:
Mailing Address - City:DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1242
Mailing Address - Country:US
Mailing Address - Phone:508-996-3991
Mailing Address - Fax:508-992-8986
Practice Address - Street 1:535 FAUNCE CORNER RD
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1242
Practice Address - Country:US
Practice Address - Phone:508-996-3991
Practice Address - Fax:508-992-8986
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2023-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA082086207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A20977Medicare ID - Type Unspecified
F57286Medicare UPIN