MEDICARE: DAVID R 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	MD041843L	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	:	1619909942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID R SMITH MD

Provider Business Mailing Address
First Line	:	33 E CHESTNUT HILL AVE
Second Line	:	SUITE 201
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-2713
Country	:	US
Telephone Number	:	215-247-0900
Fax Number	:	215-247-7696

Provider Business Practice Location Address
First Line	:	33 EAST CHESTNUT HILL AVE
Second Line	:	SUITE 201
City	:	PHILA
State	:	PA
Zip	:	19118
Country	:	US
Telephone Number	:	215-247-0900
Fax Number	:	215-247-7696

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	10/19/2012

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Directions to “ DAVID R SMITH MD” Practice Location

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