Healthcare Provider Details

I. General information

NPI: 1902038029
Provider Name (Legal Business Name): MARK V SMITH MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 BROWN RD
FRANKFORT NY
13340-4303
US

IV. Provider business mailing address

PO BOX 4218
UTICA NY
13504-4218
US

V. Phone/Fax

Practice location:
  • Phone: 315-724-4763
  • Fax: 206-984-1260
Mailing address:
  • Phone: 315-724-4763
  • Fax: 206-984-1260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number178548-1
License Number StateNY

VIII. Authorized Official

Name: DR. MARK VOGEL SMITH
Title or Position: MANAGER
Credential: MD
Phone: 315-724-4763