MEDICARE: CHESTER L SMITH JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	MD021318E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	083358	OTHER	PA	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003813585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHESTER L SMITH JR. MD

Provider Business Mailing Address
First Line	:	369 E BROWN ST
Second Line	:
City	:	EAST STROUDSBURG
State	:	PA
Zip	:	18301-9101
Country	:	US
Telephone Number	:	570-421-6040
Fax Number	:	570-421-2077

Provider Business Practice Location Address
First Line	:	369 E BROWN ST
Second Line	:
City	:	EAST STROUDSBURG
State	:	PA
Zip	:	18301-9101
Country	:	US
Telephone Number	:	570-421-6040
Fax Number	:	570-421-2077

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	03/02/2020

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