=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174617443
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AARON ROBERT SMITH M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 10/09/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2550 ELMS CENTER RD
-----------------------------------------------------
City | N CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29406-9844
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-572-7727
-----------------------------------------------------
Fax | 843-569-5881
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 LAKESIDE AVE E #1200
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44114-1158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-479-5541
-----------------------------------------------------
Fax | 216-479-5554
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 35-059298
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 16442
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------