Provider Demographics
NPI:1316932403
Name:SMITH, MARY R (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:R
Last Name:SMITH
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Gender:F
Credentials:MD
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Mailing Address - Street 1:3355 GLENDALE AVE
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2426
Mailing Address - Country:US
Mailing Address - Phone:419-383-7100
Mailing Address - Fax:419-383-2000
Practice Address - Street 1:3120 GLENDALE AVE
Practice Address - Street 2:MEDICINE
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-5811
Practice Address - Country:US
Practice Address - Phone:419-383-3747
Practice Address - Fax:419-383-6372
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
OH35041759207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0357993Medicaid
OH0357993Medicaid
OHSM0443595Medicare ID - Type Unspecified