Healthcare Provider Details

I. General information

NPI: 1659370104
Provider Name (Legal Business Name): DAVID L SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 W STATE ST STE 200
DOYLESTOWN PA
18901-2567
US

IV. Provider business mailing address

PO BOX 829641
PHILADELPHIA PA
19182-9641
US

V. Phone/Fax

Practice location:
  • Phone: 215-345-6050
  • Fax: 215-345-6568
Mailing address:
  • Phone: 267-370-5295
  • Fax: 215-230-3725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD034865E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD034865E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: