Healthcare Provider Details

I. General information

NPI: 1063472777
Provider Name (Legal Business Name): RONALD K SMITH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5126 ROUTE 30 SUITE 300
GREENSBURG PA
15601-7835
US

IV. Provider business mailing address

5126 ROUTE 30 SUITE 300
GREENSBURG PA
15601-2126
US

V. Phone/Fax

Practice location:
  • Phone: 724-836-3028
  • Fax: 724-836-3029
Mailing address:
  • Phone: 724-836-3028
  • Fax: 724-836-3029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS005252L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: