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General NPI Number Information
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NPI Number | 1720626310
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Entity Type | Organization
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Legal Business Name | CHESTER L SMITH JR MD PC
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Dates
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Enumeration Date | 12/15/2019
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Last Update Date | 12/15/2019
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Provider Practice Location Address
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Address Line | 369 E BROWN ST
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-9101
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Country | US
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Telephone | 570-421-6730
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Fax |
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Provider Business Mailing Address
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Address Line | 369 E BROWN ST
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-9101
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Country | US
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Telephone | 570-421-6730
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING ACCOUNT MANAGER
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Name | DONNA CASPER
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Credential |
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Telephone | 904-416-1021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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