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General NPI Number Information
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NPI Number | 1215970025
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Entity Type | Individual
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Provider Name | MICHAEL A SMITH PA
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Gender | Male
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 06/20/2019
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Provider Practice Location Address
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Address Line | 1250 S CEDAR CREST BLVD STE 310
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City | ALLENTOWN
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State | PA
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Zip | 18103-6224
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Country | US
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Telephone | 610-402-6890
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Fax | 610-402-6892
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Provider Business Mailing Address
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Address Line | 855 BELANGER ST STE 101
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City | HOUMA
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State | LA
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Zip | 70360-4463
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Country | US
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Telephone | 610-428-7151
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Fax | 985-850-6221
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | MA051316
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License Number State | PA
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