Provider Demographics
NPI:1972562437
Name:SMYTHE, PETER STANLEY (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:STANLEY
Last Name:SMYTHE
Suffix:
Gender:M
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:PO BOX 20452
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-0452
Mailing Address - Country:US
Mailing Address - Phone:614-442-2406
Mailing Address - Fax:614-442-2410
Practice Address - Street 1:3170 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-2945
Practice Address - Country:US
Practice Address - Phone:419-534-3500
Practice Address - Fax:419-534-2608
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057455207ZP0102X
MI4301053621207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
220008700OtherRR - MCR
MI2644384Medicaid
OH000000029112OtherANTHEM-OH
MI461127OtherBCBS - MI
OH0743217Medicaid
MI461127OtherBCBS - MI
OH000000029112OtherANTHEM-OH