Provider Demographics
NPI:1558309336
Name:SMITH, MONICA E (MD)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:E
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 COMMUNICATIONS WAY
Mailing Address - Street 2:MACC - REVENUE CYCLE
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-1866
Mailing Address - Country:US
Mailing Address - Phone:508-957-8664
Mailing Address - Fax:508-957-8677
Practice Address - Street 1:525 LONG POND DRIVE
Practice Address - Street 2:
Practice Address - City:HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02645
Practice Address - Country:US
Practice Address - Phone:508-432-4100
Practice Address - Fax:508-432-8951
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034768E207RX0202X
MA231540207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010795510002Medicaid
PA0076291000OtherINDEPENDENCE BLUE CROSS
PA070408OtherPA BLUE SHIELD
070408P4UMedicare ID - Type Unspecified
PA0010795510002Medicaid