Provider Demographics
NPI:1386734747
Name:SMITH, MARJORIE A (MD)
Entity type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1819 POLK ST
Mailing Address - Street 2:SUITE 385
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-3003
Mailing Address - Country:US
Mailing Address - Phone:415-248-1050
Mailing Address - Fax:415-248-1054
Practice Address - Street 1:2300 SUTTER ST
Practice Address - Street 2:SUITE 304
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3037
Practice Address - Country:US
Practice Address - Phone:415-248-1050
Practice Address - Fax:415-248-1054
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2014-12-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG 79504207R00000X
MA202637207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G795040Medicare ID - Type Unspecified
CAF95707Medicare UPIN