Provider Demographics
NPI:1124052410
Name:SMITH, JAMES RANDOLPH (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RANDOLPH
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2 DOGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CALIFON
Mailing Address - State:NJ
Mailing Address - Zip Code:07830-3407
Mailing Address - Country:US
Mailing Address - Phone:908-832-2347
Mailing Address - Fax:908-832-0515
Practice Address - Street 1:98 ROUTE 46
Practice Address - Street 2:
Practice Address - City:BUDD LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07828
Practice Address - Country:US
Practice Address - Phone:973-426-8484
Practice Address - Fax:973-426-8486
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA05718500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF30828Medicare UPIN