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NPI Code Detail

MEDICARE: NANCY J SMITH DO

MEDICARE: NANCY J SMITH DO
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
12084P0800XPsychiatry Physician34.050625OH
22084P0800XPsychiatry Physician3405625OH

Other Identifiers

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

General Provider Information

NPI Number : 1154343747
Entity Type Code : Individual
Provider Name (Legal Business Name) : NANCY J SMITH DO
Provider Business Mailing Address
First Line : 601 S EDWIN C MOSES BLVD
Second Line :
City : DAYTON
State : OH
Zip : 45417-3424
Country : US
Telephone Number : 937-734-8333
Fax Number : 937-384-4845
Provider Business Practice Location Address
First Line : 3095 KETTERING BLVD
Second Line :
City : MORAINE
State : OH
Zip : 45439-1983
Country : US
Telephone Number : 937-293-8300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2006
Last Update Date : 05/23/2025

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