Individual
MISS PEACHES SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6621 HASBROOK AVE, PHILA, PA 19111-4648
(215) 455-0536
(215) 455-0536
Mailing address
6621 HASBROOK AVE, PHILADELPHIA, PA 19111-4648
(215) 455-0536
(215) 455-0536
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
PA127679
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA127679
EMT
PA
Enumeration date
03/12/2022
Last updated
03/12/2022
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