Provider Demographics
NPI:1346238821
Name:SMITH, RENICK MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:RENICK
Middle Name:MATTHEW
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 745462
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-5462
Mailing Address - Country:US
Mailing Address - Phone:540-370-0430
Mailing Address - Fax:540-370-0021
Practice Address - Street 1:1500 DIXON ST STE 202
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-7231
Practice Address - Country:US
Practice Address - Phone:540-370-0430
Practice Address - Fax:540-370-0021
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2021-04-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101232557207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H60195Medicare UPIN