Provider Demographics
NPI:1699932616
Name:SMITH, DAVID LAWRENCE (CRTT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LAWRENCE
Last Name:SMITH
Suffix:
Gender:M
Credentials:CRTT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5271 WOLF RUN ROAD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:NY
Mailing Address - Zip Code:14821
Mailing Address - Country:US
Mailing Address - Phone:607-527-3286
Mailing Address - Fax:607-527-3286
Practice Address - Street 1:5271 WOLF RUN RD
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:NY
Practice Address - Zip Code:14821-9000
Practice Address - Country:US
Practice Address - Phone:607-527-3286
Practice Address - Fax:607-527-3286
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003785-12278G1100X
PAYM0112272278G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGeneral Care