Healthcare Provider Details

I. General information

NPI: 1467757419
Provider Name (Legal Business Name): SMA DEERLAKES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 ALLEGHENY RIVER BLVD
OAKMONT PA
15139-1848
US

IV. Provider business mailing address

222 ALLEGHENY RIVER BLVD
OAKMONT PA
15139-1848
US

V. Phone/Fax

Practice location:
  • Phone: 412-767-5387
  • Fax: 412-828-6642
Mailing address:
  • Phone: 412-767-5387
  • Fax: 412-828-6642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD053615L
License Number StatePA

VIII. Authorized Official

Name: DR. MICHAEL E CHISMER
Title or Position: PRESIDENT
Credential: MD
Phone: 412-767-5387