Provider Demographics
NPI:1053350272
Name:SMITH, RONALD LEE (DPM)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7125 HILLTOP RD
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-3603
Mailing Address - Country:US
Mailing Address - Phone:610-352-3373
Mailing Address - Fax:610-352-3488
Practice Address - Street 1:7125 HILLTOP RD
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-3603
Practice Address - Country:US
Practice Address - Phone:610-352-3373
Practice Address - Fax:610-352-3488
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-002658L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0940050Medicaid
PAT30493Medicare UPIN
PASM448365Medicare ID - Type Unspecified