Healthcare Provider Details

I. General information

NPI: 1164786687
Provider Name (Legal Business Name): CRAIG SMUCKER, MD ORTHOPAEDICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 06/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 GLASGOW AVE SUITE 106
NEWARK DE
19702-4773
US

IV. Provider business mailing address

900 W BALTIMORE PIKE SUITE 102
WEST GROVE PA
19390-9313
US

V. Phone/Fax

Practice location:
  • Phone: 610-869-8995
  • Fax:
Mailing address:
  • Phone: 610-869-8995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberC1-00007034
License Number StateDE

VIII. Authorized Official

Name: CRAIG SMUCKER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 610-869-8995