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NPI Code Detail

MEDICARE: DR. CHARLES R SMITH MD

MEDICARE: DR. CHARLES 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
1207LP2900XPain Medicine (Anesthesiology) Physician01047574AIN
2207L00000XAnesthesiology Physician01047574AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629075080
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES R SMITH MD
Provider Business Mailing Address
First Line : 8450 NORTHWEST BLVD.
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46278-1381
Country : US
Telephone Number : 317-802-2000
Fax Number : 317-802-2170
Provider Business Practice Location Address
First Line : 8450 NORTHWEST BLVD.
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46278-1381
Country : US
Telephone Number : 317-802-2000
Fax Number : 317-802-2170
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2005
Last Update Date : 05/16/2024

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Directions to “ DR. CHARLES R SMITH MD” Practice Location

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