Healthcare Provider Details

I. General information

NPI: 1255333225
Provider Name (Legal Business Name): STEPHEN J SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 OLD YORK RD SUITE 119
ABINGTON PA
19001-3800
US

IV. Provider business mailing address

PO BOX 468
BERWICK PA
18603-0468
US

V. Phone/Fax

Practice location:
  • Phone: 215-481-4575
  • Fax: 215-481-4843
Mailing address:
  • Phone: 610-956-0003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberMD041879L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0012897820006
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: