Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | SC004439L | PA |
Y | 222Z00000X | Podiatrist | SC004439L | PA |
N | 213EP1101X | Primary Podiatric Medicine | SC004439L | PA |
N | 111NR0200X | Radiology | SC004439L | PA |
N | 213ER0200X | Radiology | SC004439L | PA |
N | 2081S0010X | Sports Medicine | SC004439L | PA |
N | 213ES0000X | Sports Medicine | SC004439L | PA |
N | 213ES0103X | Foot & Ankle Surgery | SC004439L | PA |
N | 213ES0131X | Foot Surgery | SC004439L | PA |
NPI | 1407828825 |
---|---|
Provider Name | Dr. Randy Michael Smargiassi |
First Address | Reading, PA 19606-3062 |
Second Address | Reading, PA 19606-3062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 03/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102002670-0004 | (05) | PA |