MEDICARE: ELLEN GEORGE 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	MD033955E	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	867633	OTHER	PA	GROUP MEDICARE #

General Provider Information

NPI Number	:	1528028594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN GEORGE SMITH MD

Provider Business Mailing Address
First Line	:	354 EQUUS DR
Second Line	:
City	:	CAMP HILL
State	:	PA
Zip	:	17011-8357
Country	:	US
Telephone Number	:	717-579-3349
Fax Number	:

Provider Business Practice Location Address
First Line	:	354 EQUUS DR
Second Line	:
City	:	CAMP HILL
State	:	PA
Zip	:	17011-8357
Country	:	US
Telephone Number	:	717-579-3349
Fax Number	:

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	11/11/2015

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