Healthcare Provider Details

I. General information

NPI: 1730171851
Provider Name (Legal Business Name): STEVEN P SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 SOUTH MANNING BLVD MEDICAL IMAGING DEPARTMENT
ALBANY NY
12208-1707
US

IV. Provider business mailing address

315 SOUTH MANNING BLVD MEDICAL IMAGING DEPARTMENT
ALBANY NY
12208-1707
US

V. Phone/Fax

Practice location:
  • Phone: 518-525-1852
  • Fax: 518-525-5187
Mailing address:
  • Phone: 518-525-1852
  • Fax: 518-525-5187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number162005
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number162005
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: