MEDICARE: MADELINE SMITH

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1275009219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE SMITH

Provider Business Mailing Address
First Line	:	5562 HOBART ST APT B3
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15217-1945
Country	:	US
Telephone Number	:	240-527-7372
Fax Number	:

Provider Business Practice Location Address
First Line	:	4041 BIGELOW BLVD APT 301
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15213-1229
Country	:	US
Telephone Number	:	240-527-7372
Fax Number	:

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

Provider Enumeration Date	:	10/17/2018
Last Update Date	:	09/03/2020

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Directions to “ MADELINE SMITH ” Practice Location

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