Healthcare Provider Details

I. General information

NPI: 1639001407
Provider Name (Legal Business Name): JUSTIN SMITH PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 NORTH ST
PITTSFIELD MA
01201-4109
US

IV. Provider business mailing address

32 DWIGHT RD
MARSHFIELD MA
02050-4402
US

V. Phone/Fax

Practice location:
  • Phone: 413-447-2000
  • Fax:
Mailing address:
  • Phone: 678-699-9520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: