Healthcare Provider Details

I. General information

NPI: 1013057827
Provider Name (Legal Business Name): CATHERINE S SMITH MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ADAMS AVE SUITE 306
SCRANTON PA
18510-2025
US

IV. Provider business mailing address

401 ADAMS AVE SUITE 306
SCRANTON PA
18510-2025
US

V. Phone/Fax

Practice location:
  • Phone: 570-963-9470
  • Fax: 570-963-9471
Mailing address:
  • Phone: 570-963-9470
  • Fax: 570-963-9471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberMD037808E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1426109
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBLUE SHIELD PROVIDER NUMB
# 2
Identifier0011010440002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 3
Identifier161241
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerNY STATE MEDICAL LICENSE
# 4
IdentifierMD037808E
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPA MEDICAL LICENSE NUMBER
# 5
IdentifierME04113831516
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPA MEDICAL EDUCATION NUMB

VIII. Authorized Official

Name: DR. CATHERINE S SMITH
Title or Position: OWNER
Credential: MD,FACOG,RDMS
Phone: 570-963-9474