Provider Demographics
NPI:1124171038
Name:NAIR, SMITHA (MD)
Entity type:Individual
Prefix:
First Name:SMITHA
Middle Name:
Last Name:NAIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SMITHA
Other - Middle Name:RAMACHANDRAN
Other - Last Name:KOEMMEDATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6969
Practice Address - Street 1:40 V TWIN DR STE 204
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-7878
Practice Address - Country:US
Practice Address - Phone:717-339-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD66537207Q00000X
PAMD432406207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102041319Medicaid
PA113212OtherGEISINGER
913982OtherCAREFIRST MD BCBS
PA20069100OtherAMERIHEALTH MERCY-WMG
J840-0005OtherCAREFIRST MD BCBS HMO
PA216038OtherJOHNS HOPKINS
P17766OtherCAREFIRST MD BCBS POS
PA1987747OtherHIGHMARK BLUE SHIELD
MD015529200Medicaid
PA225492OtherUNISON-WMG
PA50072614OtherCAPITAL BLUE CROSS-WMG
PA9480099OtherAETNA
PA113212OtherGEISINGER
PAP00701716Medicare PIN