MEDICARE: GREGORY J SMULL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	11678	NH
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	11678	NH
3	207RS0012X	Sleep Medicine (Internal Medicine) Physician	11678	NH
4	207RP1001X	Pulmonary Disease Physician	11678	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093780520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY J SMULL MD

Provider Business Mailing Address
First Line	:	44 BIRCH ST
Second Line	:	SUITE 200
City	:	DERRY
State	:	NH
Zip	:	03038-2752
Country	:	US
Telephone Number	:	603-421-2380
Fax Number	:	603-421-2386

Provider Business Practice Location Address
First Line	:	4129 N ARMENIA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6436
Country	:	US
Telephone Number	:	138-793-6998
Fax Number	:	813-873-8469

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2006
Last Update Date	:	02/19/2020

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Directions to “ GREGORY J SMULL MD” Practice Location

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