Smith, Marissa M

Smith, Marissa M is an individual health care provider with primary practice located at 4900 Broad Road , Syracuse NY 13215. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Pediatrics is her primary health care specialty. Smith, Marissa M can be contacted via phone (315) 492-5437.

Contact Information

Primary practice address
4900 Broad Road Syracuse NY 13215
Phone: (315) 492-5437
Fax: (315) 492-5502
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 050185 Connecticut
Allopathic & Osteopathic Physicians / Sports Medicine 2080S0010X 050185 Connecticut
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 275336 New York

Profile Details

NPI number 1427218833
LBN Legal business name Smith, Marissa M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 10th, 2008
Last updated Nov 3rd, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1427218833 NPPES
New York MEDICAID 03378998

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