Provider Demographics
NPI:1871932533
Name:SMITH, JARED M (MD)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:M
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:571 SAINT JOSEPHS BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3230
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:607-873-1244
Practice Address - Street 1:100 JOHN ROEMMELT DR STE 102
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-8302
Practice Address - Country:US
Practice Address - Phone:607-795-1666
Practice Address - Fax:607-796-0839
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101263850207X00000X
NY297745207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103666997Medicaid
NY05595139Medicaid