MEDICARE: GERALD FRANCIS SMITH PA-C

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	363AM0700X	Medical Physician Assistant	MA051855	PA

General Provider Information

NPI Number	:	1417985326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALD FRANCIS SMITH PA-C

Provider Business Mailing Address
First Line	:	1015 CHESTNUT ST
Second Line	:	SUITE 810
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4316
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1015 CHESTNUT ST
Second Line	:	SUITE 810
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4316
Country	:	US
Telephone Number	:	215-574-0075
Fax Number	:

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	07/19/2013

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