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General NPI Number Information
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NPI Number | 1609802867
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Entity Type | Organization
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Legal Business Name | OLIVIA SMITH-BLACKWELL MD PC
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 01/26/2011
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Provider Practice Location Address
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Address Line | 533 MEADOW DR #2
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-2835
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Country | US
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Telephone | 716-693-4600
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Fax | 716-693-4807
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Provider Business Mailing Address
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Address Line | 908 NIAGARA FALLS BLVD SUITE 208
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-2019
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Country | US
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Telephone | 716-692-3302
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Fax | 716-332-3525
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Authorized Official
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Title or Position | OWNER
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Name | OLIVIA SMITH-BLACKWELL
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Credential | MD
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Telephone | 716-693-4600
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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 |
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License Number State |
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