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General NPI Number Information
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NPI Number | 1467717116
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Entity Type | Organization
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Legal Business Name | SMITH MEDICINE, PC
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Dates
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Enumeration Date | 07/09/2012
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Last Update Date | 02/24/2017
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Provider Practice Location Address
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Address Line | 100 E LANCASTER AVE MOB EAST #450
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City | WYNNEWOOD
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State | PA
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Zip | 19096-3450
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Country | US
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Telephone | 610-896-0648
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Fax | 610-642-1690
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Provider Business Mailing Address
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Address Line | 100 E LANCASTER AVE MOB EAST #450
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City | WYNNEWOOD
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State | PA
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Zip | 19096-3450
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Country | US
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Telephone | 610-896-0648
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Fax | 610-642-1690
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | DR. BRADLEY JASON SMITH
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Credential | M.D.
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Telephone | 215-668-4613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | MD427776
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License Number State | PA
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