Healthcare Provider Details

I. General information

NPI: 1821080409
Provider Name (Legal Business Name): PETER C SMITH DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 GRANITE RUN DRIVE SUITE 160
LANCASTER PA
17601-6809
US

IV. Provider business mailing address

300 GRANITE RUN DRIVE SUITE 160
LANCASTER PA
17601-6809
US

V. Phone/Fax

Practice location:
  • Phone: 717-560-4310
  • Fax: 717-560-3452
Mailing address:
  • Phone: 717-560-4310
  • Fax: 717-560-3452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC003298L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: