MEDICARE: JONATHAN G SMITH M.D.

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	207R00000X	Internal Medicine Physician	214027	MA

General Provider Information

NPI Number	:	1023057015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN G SMITH M.D.

Provider Business Mailing Address
First Line	:	109 ANDREW AVE
Second Line	:	SUITE 203
City	:	WAYLAND
State	:	MA
Zip	:	01778-3156
Country	:	US
Telephone Number	:	508-358-3300
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 ANDREW AVE
Second Line	:	SUITE 203
City	:	WAYLAND
State	:	MA
Zip	:	01778-3156
Country	:	US
Telephone Number	:	508-358-3300
Fax Number	:

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	05/12/2017

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