MEDICARE: ELLIOT L 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	MD053373L	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
2	P00232506	OTHER	PA	RR MED INDIV #

General Provider Information

NPI Number	:	1396741492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLIOT L SMITH M.D.

Provider Business Mailing Address
First Line	:	217 E MAIN ST
Second Line	:
City	:	EVANS CITY
State	:	PA
Zip	:	16033-1219
Country	:	US
Telephone Number	:	724-538-9700
Fax Number	:	724-538-9710

Provider Business Practice Location Address
First Line	:	217 E MAIN ST
Second Line	:
City	:	EVANS CITY
State	:	PA
Zip	:	16033-1219
Country	:	US
Telephone Number	:	724-538-9700
Fax Number	:	724-538-9710

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	02/25/2015

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