Provider Demographics
NPI:1336139260
Name:SMITH, PETER R (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:R
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 1:511 PARK HILL DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3377
Mailing Address - Country:US
Mailing Address - Phone:540-371-5660
Mailing Address - Fax:540-372-6920
Practice Address - Street 1:511 PARK HILL DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3377
Practice Address - Country:US
Practice Address - Phone:540-371-5660
Practice Address - Fax:540-372-6920
Is Sole Proprietor?:No
Enumeration Date:2005-10-22
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101022178207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7603924Medicaid
VA2041934001OtherCIGNA
VA2542332OtherAETNA
VA7037246OtherAETNA
VA140954OtherSOUTHERN HEALTH
VAJ063-0001OtherCAREFIRST
VA102826OtherBLUE CROSS
VA02-00161OtherUNITED HEALTHCARE
VA67112OtherALLIANCE/MAMSI
B05662Medicare UPIN