Healthcare Provider Details

I. General information

NPI: 1780945634
Provider Name (Legal Business Name): SMITH MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 10/16/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 E LANCASTER AVE STE 200
WYNNEWOOD PA
19096-3430
US

IV. Provider business mailing address

6 E LANCASTER AVE STE 200
WYNNEWOOD PA
19096-3430
US

V. Phone/Fax

Practice location:
  • Phone: 610-896-0648
  • Fax: 610-642-1690
Mailing address:
  • Phone: 610-896-0648
  • Fax: 610-642-1690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD427776
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD431430
License Number StatePA

VIII. Authorized Official

Name: DR. AMY MILLER SMITH
Title or Position: PRESIDENT
Credential: MD
Phone: 267-970-7117