Healthcare Provider Details

I. General information

NPI: 1376741892
Provider Name (Legal Business Name): ANDREW BREWSTER SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 05/13/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 VALLEY ST.
DAYTON OH
45404
US

IV. Provider business mailing address

PO BOX 933421
CLEVELAND OH
44193-0039
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-3060
  • Fax: 937-764-1328
Mailing address:
  • Phone: 937-641-5072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number35.099479
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: