Provider Demographics
NPI:1063961639
Name:EDWARD N. SMOLAR, MD PA
Entity type:Organization
Organization Name:EDWARD N. SMOLAR, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SMOLAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-491-6200
Mailing Address - Street 1:3075 E COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4318
Mailing Address - Country:US
Mailing Address - Phone:954-491-6200
Mailing Address - Fax:954-491-6419
Practice Address - Street 1:3075 E COMMERCIAL BLVD
Practice Address - Street 2:SUITE 1A
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4318
Practice Address - Country:US
Practice Address - Phone:954-491-6200
Practice Address - Fax:954-491-6419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME16517207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME16517OtherMEDICAL LICENSE