Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | MD041879L | PA |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | MD041879L | PA |
NPI | 1255333225 |
---|---|
Provider Name | Stephen J Smith |
First Address | Berwick, PA 18603-0468 |
Second Address | Abington, PA 19001-3800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 05/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0012897820006 | (05) | PA |
F88171 | (02) | PA |