Provider Demographics
NPI:1609846096
Name:SMITH, EDWARD R (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:R
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:BADER 3
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-8414
Mailing Address - Fax:617-730-0906
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:BADER 3
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-8414
Practice Address - Fax:617-730-0906
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2018-04-17
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Provider Licenses
StateLicense IDTaxonomies
MA161140207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30203759OtherMEDICAID HEALTH KIDS
MA710422OtherTUFTS HEALTH
MAM14829OtherBCBS
VT1010970OtherVT MEDICAID
MAAA8312OtherHARVARD PILGRIM HEALTH
MA3159607OtherAETNA
MA710422OtherTUFTS HEALTH PLAN
MA9757597Medicaid
VT1010970OtherVT MEDICAID
MA9757597Medicaid