MEDICARE: DR. PETER STANLEY SMYTHE 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	35057455	OH
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	4301053621	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	220008700	OTHER		RR - MCR
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000029112	OTHER	OH	ANTHEM-OH
4	461127	OTHER	MI	BCBS - MI
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972562437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER STANLEY SMYTHE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 20452
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-0452
Country	:	US
Telephone Number	:	614-442-2406
Fax Number	:	614-442-2410

Provider Business Practice Location Address
First Line	:	3170 W CENTRAL AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-2945
Country	:	US
Telephone Number	:	419-534-3500
Fax Number	:	419-534-2608

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

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	12/03/2013

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