Healthcare Provider Details

I. General information

NPI: 1396364337
Provider Name (Legal Business Name): CHRISTA SMALTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CHESTNUT ST STE 220
PHILADELPHIA PA
19107-4405
US

IV. Provider business mailing address

833 CHESTNUT ST STE 220
PHILADELPHIA PA
19107-4405
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-8465
  • Fax: 215-955-2516
Mailing address:
  • Phone: 215-955-8465
  • Fax: 215-955-2516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA13083300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD480433
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: