Provider Demographics
NPI:1164446563
Name:SMITH, PATRICIA D (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8625 SUDLEY RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4515
Mailing Address - Country:US
Mailing Address - Phone:703-361-3434
Mailing Address - Fax:703-361-6252
Practice Address - Street 1:8625 SUDLEY RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4515
Practice Address - Country:US
Practice Address - Phone:703-361-3434
Practice Address - Fax:703-361-6252
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101046481207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2522-0005OtherCARE FIRST PROVIDER ID
VA227705OtherANTHEM PROVIDER ID
VAC04856Medicare ID - Type Unspecified
VA227705OtherANTHEM PROVIDER ID