Healthcare Provider Details

I. General information

NPI: 1114924719
Provider Name (Legal Business Name): HARRY BART SMELTZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2005
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST 6 DULLES
PHILADELPHIA PA
19104-4206
US

IV. Provider business mailing address

3400 SPRUCE ST 6 DULLES
PHILADELPHIA PA
19104-4206
US

V. Phone/Fax

Practice location:
  • Phone: 215-349-8310
  • Fax: 215-545-1543
Mailing address:
  • Phone: 215-349-8310
  • Fax: 215-545-1543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOS007691L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: