Provider Demographics
NPI:1023046208
Name:SMITH, PAMELA B (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:B
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3806 POPLAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5533
Mailing Address - Country:US
Mailing Address - Phone:757-483-4600
Mailing Address - Fax:757-484-2323
Practice Address - Street 1:3806 POPLAR HILL RD STE C
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5533
Practice Address - Country:US
Practice Address - Phone:757-483-4600
Practice Address - Fax:757-484-2323
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101046089207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6211194Medicaid