Basic Information
| Provider Information | |||||||||
| NPI: | 1578984498 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CRAIG SMUCKER MD ORTHOPAEDICS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SMUCKER ORTHOPAEDICS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 W BALTIMORE PIKE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | WEST GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193909313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108695757 | ||||||||
| FaxNumber: | 6108696544 | ||||||||
| Practice Location | |||||||||
| Address1: | 5936 LIMESTONE RD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | HOCKESSIN | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197078930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108695757 | ||||||||
| FaxNumber: | 6108696544 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2013 | ||||||||
| LastUpdateDate: | 12/18/2013 | ||||||||
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| AuthorizedOfficialLastName: | SMUCKER | ||||||||
| AuthorizedOfficialFirstName: | CRAIG | ||||||||
| AuthorizedOfficialMiddleName: | GORDON | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6108695757 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | C1000-7034 | DE | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
No ID Information.