Healthcare Provider Details

I. General information

NPI: 1477509602
Provider Name (Legal Business Name): ALAN C SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 POWERS RD
ORCHARD PARK NY
14127-4841
US

IV. Provider business mailing address

2875 UNION ROAD SUITE 8
CHEEKTOWAGA NY
14227-1461
US

V. Phone/Fax

Practice location:
  • Phone: 716-667-0001
  • Fax:
Mailing address:
  • Phone: 716-651-0911
  • Fax: 716-651-9855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number146797
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: