MEDICARE: DAVID ROBERT 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	208000000X	Pediatrics Physician	241710-1	NY

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	:	1558343285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ROBERT SMITH M.D.

Provider Business Mailing Address
First Line	:	90 PRESIDENTIAL PLZ
Second Line	:	3RD FLOOR
City	:	SYRACUSE
State	:	NY
Zip	:	13202-2240
Country	:	US
Telephone Number	:	315-464-4357
Fax Number	:	315-464-2030

Provider Business Practice Location Address
First Line	:	90 PRESIDENTIAL PLZ
Second Line	:	3RD FLOOR
City	:	SYRACUSE
State	:	NY
Zip	:	13202-2240
Country	:	US
Telephone Number	:	315-464-4357
Fax Number	:	315-464-2030

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

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	06/24/2010

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