Provider Demographics
NPI:1154382604
Name:SMITH, DEBORAH ANN (MD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1605 N CEDAR CREST BLVD
Mailing Address - Street 2:STE. 110B
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2351
Mailing Address - Country:US
Mailing Address - Phone:610-973-1410
Mailing Address - Fax:610-973-1449
Practice Address - Street 1:1580 CENTER AVE
Practice Address - Street 2:
Practice Address - City:JIM THORPE
Practice Address - State:PA
Practice Address - Zip Code:18229-1012
Practice Address - Country:US
Practice Address - Phone:570-325-2705
Practice Address - Fax:484-403-4054
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-023853-E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007751530001Medicaid
PA047276Medicare ID - Type Unspecified
PA0007751530001Medicaid