Healthcare Provider Details

I. General information

NPI: 1407018963
Provider Name (Legal Business Name): ANDREW W SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 12/03/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 LINDEN OAKS SUITE 310
ROCHESTER NY
14625-2814
US

IV. Provider business mailing address

360 LINDEN OAKS SUITE 310
ROCHESTER NY
14625-2814
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-5840
  • Fax: 585-586-7558
Mailing address:
  • Phone: 585-922-5840
  • Fax: 585-586-7558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number196397
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number196397
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number196397
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: