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General NPI Number Information
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NPI Number | 1457477358
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Entity Type | Individual
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Provider Name | ETHAN ANDREW SMITH M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 09/01/2023
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Provider Practice Location Address
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Address Line | 3333 BURNET AVENUE ML 5031
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City | CINCINNATI
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State | OH
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Zip | 45229-3026
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Country | US
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Telephone | 513-636-4251
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Fax | 513-636-8145
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Provider Business Mailing Address
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Address Line | 3333 BURNET AVENUE ML 5031
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City | CINCINNATI
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State | OH
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Zip | 45229-3026
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Country | US
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Telephone | 513-636-4251
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Fax | 513-636-8145
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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 | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number | 50483
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 4301086310
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number | 35.095027
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License Number State | OH
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