Basic Information
| Provider Information | |||||||||
| NPI: | 1063413631 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 COMMUNICATION WAY | ||||||||
| Address2: | |||||||||
| City: | HYANNIS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089578664 | ||||||||
| FaxNumber: | 5089578677 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 TER HEUN DRIVE | ||||||||
| Address2: | FALMOUTH HOSPITAL | ||||||||
| City: | FALMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084573748 | ||||||||
| FaxNumber: | 5084573749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 04/14/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | L0939 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 226421 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 147043702 | 05 | TX | MEDICAID | J29309 | 01 | MA | BCBS | OTHER |