Provider Demographics
NPI:1063745339
Name:SMITH, CATHY (MD)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:
Other - Last Name:SCHANBERGER SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5730 EXECUTIVE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1762
Mailing Address - Country:US
Mailing Address - Phone:610-387-4520
Mailing Address - Fax:610-387-4526
Practice Address - Street 1:100 MARIS GROVE WAY
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1282
Practice Address - Country:US
Practice Address - Phone:610-387-4520
Practice Address - Fax:610-387-4526
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039961L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00893867 - RRMedicare PIN
PA164566R3WMedicare PIN