Provider Demographics
NPI:1386604742
Name:SMITH, STEVEN PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:PAUL
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-6219
Mailing Address - Country:US
Mailing Address - Phone:781-235-8855
Mailing Address - Fax:
Practice Address - Street 1:332 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-6219
Practice Address - Country:US
Practice Address - Phone:781-235-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA057991207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ06438OtherBLUE CROSS BLUE SHIELD
MA057991OtherTUFTS MEDICARE PREFERRED
MA03-00003OtherUNITED HEALTHCARE
MA057991OtherTUFTS HEALTHPLAN
MA401115OtherHARVARD PILGRIM HEALTHCAR
MAJ06438OtherBLUE CROSS BLUE SHIELD
MAA21780Medicare PIN