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General NPI Number Information
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NPI Number | 1154327161
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Entity Type | Individual
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Provider Name | MILAGROS C SMITH P.A.
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Gender | Female
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Dates
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Enumeration Date | 06/23/2005
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 727 WASHINGTON ST
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City | WATERTOWN
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State | NY
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Zip | 13601-4031
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Country | US
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Telephone | 315-785-7009
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Fax | 315-785-7566
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Provider Business Mailing Address
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Address Line | PO BOX 91
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City | WATERTOWN
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State | NY
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Zip | 13601-0091
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Country | US
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Telephone | 315-782-4207
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Fax | 315-782-8699
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 005734-1
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License Number State | NY
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