Provider Demographics
NPI:1588686968
Name:SMITH, AMY BARBARA (PA-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:BARBARA
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:BARBARA
Other - Last Name:VERBITSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1140 WELSH RD STE 130
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-2046
Mailing Address - Country:US
Mailing Address - Phone:973-571-2121
Mailing Address - Fax:267-642-9089
Practice Address - Street 1:1140 WELSH RD STE 130
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-2046
Practice Address - Country:US
Practice Address - Phone:973-571-2121
Practice Address - Fax:267-642-9089
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052612363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical