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General NPI Number Information
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NPI Number | 1083862932
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Entity Type | Organization
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Legal Business Name | DAVID SMITH MD
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Dates
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Enumeration Date | 09/04/2008
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Last Update Date | 09/04/2008
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Provider Practice Location Address
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Address Line | 9 ELM ST
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City | PERU
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State | NY
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Zip | 12972-2812
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Country | US
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Telephone | 518-643-7037
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Fax | 518-643-2125
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Provider Business Mailing Address
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Address Line | PO BOX 599 9 ELM STREET
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City | PERU
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State | NY
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Zip | 12972-0599
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Country | US
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Telephone | 518-643-7037
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Fax | 518-643-2125
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Authorized Official
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Title or Position | BILLING MGR
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Name | VIKKI LAIDMAN
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Credential | CPC, CCS-P
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Telephone | 518-563-8290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 190218
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License Number State | NY
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