Healthcare Provider Details

I. General information

NPI: 1093620445
Provider Name (Legal Business Name): JACOB SMITH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 FORBES AVE
PITTSBURGH PA
15213-3410
US

IV. Provider business mailing address

2733 HILLTOP RD
OAKDALE PA
15071-2100
US

V. Phone/Fax

Practice location:
  • Phone: 412-647-8635
  • Fax:
Mailing address:
  • Phone: 412-398-7204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA067822
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: