Provider Demographics
NPI:1871558049
Name:SMITH, G DAVID (PHD)
Entity type:Individual
Prefix:DR
First Name:G
Middle Name:DAVID
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2818 GREEN STREET
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-1228
Mailing Address - Country:US
Mailing Address - Phone:717-238-6880
Mailing Address - Fax:717-238-6885
Practice Address - Street 1:2818 GREEN STREET
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-1228
Practice Address - Country:US
Practice Address - Phone:717-238-6880
Practice Address - Fax:717-238-6885
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002423L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01413901OtherCAPITAL BLUE CROSS
PA0013914090002Medicaid
PA029234J6PMedicare ID - Type Unspecified