Provider Demographics
NPI:1043251051
Name:SMITH, JOSEPH L II (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:L
Last Name:SMITH
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 ARRANDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2503
Mailing Address - Country:US
Mailing Address - Phone:610-363-2532
Mailing Address - Fax:610-363-0210
Practice Address - Street 1:111 ARRANDALE BLVD
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2503
Practice Address - Country:US
Practice Address - Phone:610-363-2532
Practice Address - Fax:610-363-0210
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428520207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016804500001Medicaid
PAI54266Medicare UPIN
PA1016804500001Medicaid