Provider Demographics
NPI:1427095728
Name:SMITH, JOHN GERARD (PA-C)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:GERARD
Last Name:SMITH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 QUEEN CITY AVE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-7121
Mailing Address - Country:US
Mailing Address - Phone:603-627-1102
Mailing Address - Fax:603-647-5524
Practice Address - Street 1:185 QUEEN CITY AVE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-7121
Practice Address - Country:US
Practice Address - Phone:603-627-1102
Practice Address - Fax:603-647-5524
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0157363AM0700X
NH0571363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3077022Medicaid
P00331200OtherRAILROAD MEDICARE
NHP00394782OtherRAILROAD
ME320420099Medicaid
P00331200OtherRAILROAD MEDICARE
NH30333988Medicaid
NHAP257301Medicare PIN