Provider Demographics
NPI:1427168632
Name:SMITH, PAUL S (CRNA)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:S
Last Name:SMITH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 372
Mailing Address - Street 2:MASSACHUSETTS ANESTHESIA CORP.
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072
Mailing Address - Country:US
Mailing Address - Phone:781-341-3966
Mailing Address - Fax:781-341-8269
Practice Address - Street 1:282 ROUTE 130
Practice Address - Street 2:C/O CAPE COD EYE SURGERY & LASER CTR
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563
Practice Address - Country:US
Practice Address - Phone:508-427-3720
Practice Address - Fax:952-442-3620
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA185096367500000X
MA185098367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANA0363OtherBLUE CROSS OF MASS
MANA0363Medicare ID - Type UnspecifiedMEDICARE OF MASS