MEDICARE: AMY BARBARA 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	MA052612	PA

General Provider Information

NPI Number	:	1588686968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY BARBARA SMITH PA-C

Provider Business Mailing Address
First Line	:	1140 WELSH RD STE 130
Second Line	:
City	:	NORTH WALES
State	:	PA
Zip	:	19454-2046
Country	:	US
Telephone Number	:	973-571-2121
Fax Number	:	267-642-9089

Provider Business Practice Location Address
First Line	:	1140 WELSH RD STE 130
Second Line	:
City	:	NORTH WALES
State	:	PA
Zip	:	19454-2046
Country	:	US
Telephone Number	:	973-571-2121
Fax Number	:	267-642-9089

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	02/06/2024

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