Provider Demographics
NPI:1881786598
Name:SMITH, EILEEN M (PA)
Entity type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:15 S MAIN ST
Mailing Address - Street 2:STE 150 - INTERNAL MEDICINE
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6626
Mailing Address - Country:US
Mailing Address - Phone:716-488-1877
Mailing Address - Fax:716-488-1986
Practice Address - Street 1:15 S MAIN ST
Practice Address - Street 2:STE 150 - INTERNAL MEDICINE
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6626
Practice Address - Country:US
Practice Address - Phone:716-488-1877
Practice Address - Fax:716-488-1986
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2024-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY006401-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ36059Medicare UPIN
NYPA0674Medicare ID - Type Unspecified