Provider Demographics
NPI:1043254477
Name:SMITH, GEORGE ROBERT (MD)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:ROBERT
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 1:220 CHAMPION DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6665
Mailing Address - Country:US
Mailing Address - Phone:301-791-0888
Mailing Address - Fax:301-791-3611
Practice Address - Street 1:219 S SPRING ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-4230
Practice Address - Country:US
Practice Address - Phone:301-791-0888
Practice Address - Fax:304-267-5884
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD09839207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7058909Medicaid
RI7058909Medicaid
C81983Medicare UPIN