MEDICARE: SUSAN J. SMITH 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	2084P0800X	Psychiatry Physician	G73621	CA

General Provider Information

NPI Number	:	1194843607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN J. SMITH MD

Provider Business Mailing Address
First Line	:	2415 UNIVERSITY AVE STE 301
Second Line	:
City	:	EAST PALO ALTO
State	:	CA
Zip	:	94303-1148
Country	:	US
Telephone Number	:	650-363-4030
Fax Number	:	650-328-6834

Provider Business Practice Location Address
First Line	:	2415 UNIVERSITY AVE STE 301
Second Line	:
City	:	EAST PALO ALTO
State	:	CA
Zip	:	94303-1148
Country	:	US
Telephone Number	:	650-363-4030
Fax Number	:	650-328-6834

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	12/23/2020

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