Provider Demographics
NPI:1366496036
Name:SMITH, JOSHUA RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:RICHARD
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 1:24 ISLAND VIEW DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-7471
Mailing Address - Country:US
Mailing Address - Phone:757-969-5372
Mailing Address - Fax:
Practice Address - Street 1:SENTARA CAREPLEX HOSPITAL
Practice Address - Street 2:3000 COLISEUM DRIVE
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666
Practice Address - Country:US
Practice Address - Phone:757-736-2008
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238086207P00000X
FLME91802207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAI32202Medicare UPIN
VA007593P21Medicare ID - Type Unspecified