Basic Information
| Provider Information | |||||||||
| NPI: | 1083682520 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | DARELL | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 480 W HIGHLAND DR | ||||||||
| Address2: | |||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437011227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404549766 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2845 BELL ST | ||||||||
| Address2: | |||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437011720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404549766 | ||||||||
| FaxNumber: | 7405886452 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 2084P0800X | 35-02-2114S | OH | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 7855135 | 01 | OH | AETNA PIN | OTHER | 0205754 | 05 | OH | MEDICAID | 373631 | 01 | OH | TRICARE/MHN PIN | OTHER | Y021934 | 01 | OH | THE HEALTH PLAN PIN | OTHER | 153521 | 01 | OH | COMPSYCH BH PIN | OTHER | 67772 | 01 | OH | CIGNA BH PIN | OTHER | 9071401 | 01 | OH | PRIVATE HLTHCARE SYS PIN | OTHER | 000000116795 | 01 | OH | ANTHEM PIN | OTHER | 226307000 | 01 | OH | MAGELLAN PIN | OTHER | 245401 | 01 | OH | MOUNT CARMEL PIN | OTHER | C00406 | 05 | OH | MEDICAID | 1512577 | 01 | OH | UBH PIN | OTHER |