Provider Demographics
NPI:1992984249
Name:ANN G SMITH M.D.,P.C.
Entity type:Organization
Organization Name:ANN G SMITH M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:G
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PC
Authorized Official - Phone:814-444-8300
Mailing Address - Street 1:339 W UNION ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-1543
Mailing Address - Country:US
Mailing Address - Phone:814-444-8300
Mailing Address - Fax:814-443-3959
Practice Address - Street 1:339 W UNION ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-1543
Practice Address - Country:US
Practice Address - Phone:814-444-8300
Practice Address - Fax:814-443-3959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066269L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA056162Medicare PIN