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General NPI Number Information
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NPI Number | 1154642197
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Entity Type | Individual
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Provider Name | CHARLOTTE JANE SMITH M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/14/2010
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Last Update Date | 03/15/2023
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Provider Practice Location Address
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Address Line | 2146 BARTOW AVE SPC 280E
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City | BRONX
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State | NY
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Zip | 10475-4629
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Country | US
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Telephone | 646-346-7927
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Fax |
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Provider Business Mailing Address
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Address Line | 75 DECATUR RD
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City | NEW ROCHELLE
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State | NY
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Zip | 10801-5741
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Country | US
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Telephone | 203-206-1541
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD455186
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License Number State | PA
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