Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | CPO03720 | PA |
N | 222Z00000X | Podiatrist | CPO03720 | PA |
Y | 224P00000X | Prosthetist | CPO03720 | PA |
NPI | 1285169557 |
---|---|
Provider Name | Matthew Smith |
First Address | Pittsburgh, PA 15224-1843 |
Second Address | Pittsburgh, PA 15224-1843 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2017 |
Last Update Date | 25/04/2017 |