Healthcare Provider Details

I. General information

NPI: 1598712804
Provider Name (Legal Business Name): ELAINE MARIE SMITH-MARCHANT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 S COMPASS WAY
DANIA FL
33004-2368
US

IV. Provider business mailing address

7305 N. MILITARY TRAIL MEDICINE (111)
WEST PALM BEACH FL
33410
US

V. Phone/Fax

Practice location:
  • Phone: 954-807-9433
  • Fax:
Mailing address:
  • Phone: 561-422-6650
  • Fax: 561-422-8708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME74205
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberME74205
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: