Healthcare Provider Details

I. General information

NPI: 1225297070
Provider Name (Legal Business Name): MICHELLE JANINE SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W LANCASTER AVE STE 201
PAOLI PA
19301
US

IV. Provider business mailing address

255 W LANCASTER AVE STE 201
PAOLI PA
19301-1763
US

V. Phone/Fax

Practice location:
  • Phone: 610-325-3880
  • Fax: 610-325-3887
Mailing address:
  • Phone: 610-325-3880
  • Fax: 610-325-3887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD442604
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: