Provider Demographics
NPI:1407804420
Name:SMITH, HOLLY LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:LYNN
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:PO BOX 753
Mailing Address - Street 2:
Mailing Address - City:RURAL RETREAT
Mailing Address - State:VA
Mailing Address - Zip Code:24368-0753
Mailing Address - Country:US
Mailing Address - Phone:276-686-5116
Mailing Address - Fax:276-686-6289
Practice Address - Street 1:306 SOUTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:RURAL RETREAT
Practice Address - State:VA
Practice Address - Zip Code:24368
Practice Address - Country:US
Practice Address - Phone:276-686-5116
Practice Address - Fax:276-686-6289
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047615173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005667658Medicaid
VAF25672Medicare UPIN
VA080003514Medicare ID - Type Unspecified