Healthcare Provider Details

I. General information

NPI: 1104323542
Provider Name (Legal Business Name): MATTHEW CHARLES SMITH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 8TH AVE
BETHLEHEM PA
18018-2256
US

IV. Provider business mailing address

1417 8TH AVE
BETHLEHEM PA
18018-2256
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-5210
  • Fax:
Mailing address:
  • Phone: 484-526-5210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberOS023130
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberOS023130
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: