Provider Demographics
NPI:1285672006
Name:SMITH, CLARENCE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:
Last Name:SMITH
Suffix:JR
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 1:5000 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:615 W MACPHAIL RD
Practice Address - Street 2:SUITE 206
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4309
Practice Address - Country:US
Practice Address - Phone:410-638-5101
Practice Address - Fax:410-638-6854
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD30878207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD74734Medicare UPIN