MEDICARE: DEBORAH ANN SMITH 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	207Q00000X	Family Medicine Physician	MD-023853-E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154382604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH ANN SMITH MD

Provider Business Mailing Address
First Line	:	1605 N CEDAR CREST BLVD
Second Line	:	STE. 110B
City	:	ALLENTOWN
State	:	PA
Zip	:	18104-2351
Country	:	US
Telephone Number	:	610-973-1410
Fax Number	:	610-973-1449

Provider Business Practice Location Address
First Line	:	1580 CENTER AVE
Second Line	:
City	:	JIM THORPE
State	:	PA
Zip	:	18229-1012
Country	:	US
Telephone Number	:	570-325-2705
Fax Number	:	484-403-4054

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	08/15/2016

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