Provider Demographics
NPI:1902930852
Name:SMITH, ANDREW J (AUD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 W INDEPENDENCE WAY
Mailing Address - Street 2:SUITE I
Mailing Address - City:KINGSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02881-1124
Mailing Address - Country:US
Mailing Address - Phone:401-874-9387
Mailing Address - Fax:401-874-4404
Practice Address - Street 1:25 W INDEPENDENCE WAY
Practice Address - Street 2:SUITE I
Practice Address - City:KINGSTON
Practice Address - State:RI
Practice Address - Zip Code:02881-1124
Practice Address - Country:US
Practice Address - Phone:401-874-9387
Practice Address - Fax:401-874-4404
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI000125231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI406547Medicare UPIN
RI2626-0Medicare UPIN
RI4500018Medicare UPIN