Healthcare Provider Details

I. General information

NPI: 1083908891
Provider Name (Legal Business Name): CHARLES SMOOT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 PLEASANTVILLE RD STE 202
LANCASTER OH
43130-3346
US

IV. Provider business mailing address

401 N EWING ST
LANCASTER OH
43130-3371
US

V. Phone/Fax

Practice location:
  • Phone: 740-681-9020
  • Fax:
Mailing address:
  • Phone: 740-687-8636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number34.018297
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: