Basic Information
| Provider Information | |||||||||
| NPI: | 1427041904 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 NORTH STREET | ||||||||
| Address2: | |||||||||
| City: | HYANNIS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087758282 | ||||||||
| FaxNumber: | 5087751414 | ||||||||
| Practice Location | |||||||||
| Address1: | 130 NORTH STREET | ||||||||
| Address2: | |||||||||
| City: | HYANNIS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087758282 | ||||||||
| FaxNumber: | 5087751414 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2005 | ||||||||
| LastUpdateDate: | 05/12/2008 | ||||||||
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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 | 207X00000X | 221560 | MA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | AA18638 | 01 | PILGRIM CIGNA | OTHER | 469686 | 01 | TUFTS | OTHER | 9773983 | 05 | MA | MEDICAID | 2080834 | 05 | MA | MEDICAID | 2225900 | 01 | FIRST HEALTH | OTHER | AA18638 | 01 | MA | HARVARD PILGRIM HEALTH CARE | OTHER | M15397 | 01 | MA | MA BLUE CROSS BLUE SHIELD | OTHER | P00293039 | 01 | MA | RAILROAD MEDICARE PALMETTO GBA | OTHER | J27894 | 01 | BCBS | OTHER | M15397 | 01 | GROUP NUMBER | OTHER |