Healthcare Provider Details

I. General information

NPI: 1760484679
Provider Name (Legal Business Name): JUDITH ANN SMALL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 E NORTH AVE SUITE 107
PITTSBURGH PA
15212-4740
US

IV. Provider business mailing address

490 E NORTH AVE SUITE 107
PITTSBURGH PA
15212-4740
US

V. Phone/Fax

Practice location:
  • Phone: 412-359-3376
  • Fax: 412-359-5094
Mailing address:
  • Phone: 412-359-3376
  • Fax: 412-359-5094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD026669E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: