MEDICARE: CHARLOTTE H 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	208100000X	Physical Medicine & Rehabilitation Physician	MD60279166	WA
2	2081P0004X	Spinal Cord Injury Medicine Physician	H2465	TX
3	2081P0301X	Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician	H2465	TX
4	208100000X	Physical Medicine & Rehabilitation Physician	H2465	TX

General Provider Information

NPI Number	:	1710965934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLOTTE H SMITH MD

Provider Business Mailing Address
First Line	:	2950 BUSKIRK AVE STE 300
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94597-6900
Country	:	US
Telephone Number	:	888-380-0988
Fax Number	:	289-236-3022

Provider Business Practice Location Address
First Line	:	11490 GATEWAY BLVD N
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79934-3456
Country	:	US
Telephone Number	:	888-380-0988
Fax Number	:	289-236-3022

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

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	09/07/2022

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