Healthcare Provider Details

I. General information

NPI: 1952800336
Provider Name (Legal Business Name): ROBERT SMALLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ROBERT JOHN SMALLEY MD

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UNIVERSITY DR
HERSHEY PA
17033-2360
US

IV. Provider business mailing address

3551 ROGER BROOKE DR
FORT SAM HOUSTON TX
78234-4504
US

V. Phone/Fax

Practice location:
  • Phone: 717-531-4935
  • Fax: 717-531-0336
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number1014360
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberMD481669
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberS3067
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: