MEDICARE: DR. GREGORY J 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	207R00000X	Internal Medicine Physician	58595	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	058595	OTHER	MA	TUFTS MEDICARE PREFERRED

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0016428	OTHER	MA	NEIGHBORHOOD HLTH PLAN
3	042297845	OTHER	MA	HCVM
4	042297845	OTHER	MA	TRICARE
5	042297845	OTHER	MA	DOC FIRST
6	4219050	OTHER	MA	AETNA
7	042297845	OTHER	MA	PRIVATE HEALTHCARE SYSTEM
8	042297845	OTHER	MA	UNITED HEALTH CARE
9	058595	OTHER	MA	TUFTS
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	B10355401	OTHER	MA	CIGNA
12	J07003	OTHER	MA	BCBS
13	042297845	OTHER	MA	GREAT WEST HEALTH CARE
14	62309	OTHER	MA	HVD PILGRIM HEALTH CARE

General Provider Information

NPI Number	:	1568445427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY J SMITH MD

Provider Business Mailing Address
First Line	:	110 W SQUANTUM ST
Second Line	:
City	:	NORTH QUINCY
State	:	MA
Zip	:	02171-2122
Country	:	US
Telephone Number	:	617-376-3000
Fax Number	:	617-774-1905

Provider Business Practice Location Address
First Line	:	110 W SQUANTUM ST
Second Line	:
City	:	NORTH QUINCY
State	:	MA
Zip	:	02171-2122
Country	:	US
Telephone Number	:	617-376-3000
Fax Number	:	617-774-1905

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

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	01/15/2016

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