Provider Demographics
NPI:1063244929
Name:SMITH, NATHANIEL ARTHUR (PA-C)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:ARTHUR
Last Name:SMITH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 BROOKMEADE DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-1764
Mailing Address - Country:US
Mailing Address - Phone:412-508-2766
Mailing Address - Fax:
Practice Address - Street 1:1020 CENTER AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15229-1724
Practice Address - Country:US
Practice Address - Phone:412-931-3066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA065846207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine