Provider Demographics
NPI:1992760219
Name:SMITH, MICHAEL DAVID (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 MIDDLETOWN BLVD SUITE #301
Mailing Address - Street 2:PO BOX 908
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-6335
Mailing Address - Country:US
Mailing Address - Phone:267-568-2042
Mailing Address - Fax:215-750-2611
Practice Address - Street 1:320 MIDDLETOWN BLVD
Practice Address - Street 2:STE 301
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-3205
Practice Address - Country:US
Practice Address - Phone:215-757-5400
Practice Address - Fax:215-750-2611
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005896L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA039614OtherHIGHMARK BLUE SHIELD
PA30072273OtherKEYSTONE MERCY
PA45738OS005896LOtherHEALTH PARTNERS
PA0022608000OtherKEYSTONE IBC
PA0015595920001Medicaid
PA0019841OtherAETNA
PA30072273OtherKEYSTONE MERCY
PA039614GH2Medicare PIN