1376549535 NPI number — DR. LORA JANE SMITH OD

Table of content: DR. LORA JANE SMITH OD (NPI 1376549535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376549535 NPI number — DR. LORA JANE SMITH OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
LORA
Provider Middle Name:
JANE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376549535
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/20/2006
NPI Reactivation Date:
03/28/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4854 LONDONDERRY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17109-5207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-657-3682
Provider Business Mailing Address Fax Number:
717-909-9162

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4854 LONDONDERRY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17109-5207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-657-3682
Provider Business Practice Location Address Fax Number:
717-909-9162
Provider Enumeration Date:
06/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG 000015 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 992170 . This is a "KEYSTONE HEALTH SERVICES" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50001250 . This is a "CAPTIAL BLUE CROS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 798437-004 . This is a "CIGNA HEALTH CARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: SM196369 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 151427 . This is a "HEALTH AMERICA/ASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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