Mark A Smith, M.D., PHD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

ME157826 Issued in FL

Practice address

1025 S Yachtsman Dr
Sanibel, FL 33957-5012

Phone

(410) 441-9714

NPI assigned

Oct 1, 2006

Last updated

Sep 11, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Norman Broudy

  dba Norman Broudy and Associates

  • Psychiatry Physician
  • Wilmington, DE
  • NPI 1457400657

  Single Specialty

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726012800000",
    "number": "1811080153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32008 ANCHORAGE LN",
            "city": "GALENA",
            "state": "MD",
            "postal_code": "216351821",
            "telephone_number": "410-441-9714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 S YACHTSMAN DR",
            "city": "SANIBEL",
            "state": "FL",
            "postal_code": "339575012",
            "telephone_number": "410-441-9714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MARK",
        "middle_name": "A",
        "credential": "M.D., PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-01",
        "last_updated": "2024-09-11",
        "certification_date": "2024-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "DE",
            "license": "C1-0007086",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME157826",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100040241",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sanibel Internal Medicine LLC
• Sanibel Island Dental LLC
• Sanibel Medical, Inc.
• Sarah Thiessen, PLLC (Island Waters Counseling)
• Scott L Dunavant MD, Inc
• Susan Klemmer LLC
• Thiessen Counseling Services
• Sarah Marie Thiessen, PH.D., LCPC, LMHC
• Joseph Michael Tolisano, D.C.
• Rachel Salvage Tritaik, PT

• Psychiatry Physician in Sanibel, FL
• Providers in Sanibel, FL by specialty
• Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.