Healthcare Provider Details

I. General information

NPI: 1063413631
Provider Name (Legal Business Name): DONALD SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 TER HEUN DRIVE FALMOUTH HOSPITAL
FALMOUTH MA
02540
US

IV. Provider business mailing address

25 COMMUNICATION WAY
HYANNIS MA
02601
US

V. Phone/Fax

Practice location:
  • Phone: 508-457-3748
  • Fax: 508-457-3749
Mailing address:
  • Phone: 508-957-8664
  • Fax: 508-957-8677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL0939
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number226421
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: