Provider Demographics
NPI:1114965373
Name:SMOLARZ, JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:SMOLARZ
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:PO BOX 12390
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00801-5390
Mailing Address - Country:US
Mailing Address - Phone:340-774-8881
Mailing Address - Fax:340-776-9807
Practice Address - Street 1:9149 ESTATE THOMAS STE 308
Practice Address - Street 2:
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-3132
Practice Address - Country:US
Practice Address - Phone:340-774-8881
Practice Address - Fax:340-776-9807
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200496208600000X
VI1634174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1072451Medicaid
LA1072451Medicaid
LAI46062Medicare UPIN