Provider Demographics
NPI:1417160524
Name:SMITH, TOVIA MARTIROSIAN (MD)
Entity Type:Individual
Prefix:
First Name:TOVIA
Middle Name:MARTIROSIAN
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 1:7130 GLEN FOREST DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3754
Mailing Address - Country:US
Mailing Address - Phone:804-282-1095
Mailing Address - Fax:804-282-8678
Practice Address - Street 1:7515 RIGHT FLANK RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-3818
Practice Address - Country:US
Practice Address - Phone:804-288-4084
Practice Address - Fax:804-559-2046
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101255371207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VVC732AOtherMEDICARE PTAN
VA1417160524Medicaid