Provider Demographics
NPI:1548270069
Name:SMITH, BRIAN DREW (MD)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:DREW
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SOUTH AVE
Mailing Address - Street 2:BOX 67
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-2733
Mailing Address - Country:US
Mailing Address - Phone:585-341-6622
Mailing Address - Fax:585-341-8236
Practice Address - Street 1:1000 SOUTH AVE
Practice Address - Street 2:BOX 67
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-2733
Practice Address - Country:US
Practice Address - Phone:585-341-6622
Practice Address - Fax:585-341-8236
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138833207RH0000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00782976Medicaid
0969OtherBLUE SHIELD
NY00782976Medicaid
0969OtherBLUE SHIELD