Healthcare Provider Details

I. General information

NPI: 1902060551
Provider Name (Legal Business Name): DAVID SMOGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 FELLOWSHIP RD STE 200
MOUNT LAUREL NJ
08054-3437
US

IV. Provider business mailing address

1415 WESLEYS RUN
GLADWYNE PA
19035-1049
US

V. Phone/Fax

Practice location:
  • Phone: 856-229-0696
  • Fax:
Mailing address:
  • Phone: 267-939-5788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT182000
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number25MA10626800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD427228
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMT182000
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME163667
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: