Provider Demographics
NPI:1417956657
Name:SMITH, CHADWICK RAY (MD)
Entity Type:Individual
Prefix:
First Name:CHADWICK
Middle Name:RAY
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:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:25213-0485
Mailing Address - Country:US
Mailing Address - Phone:304-382-3118
Mailing Address - Fax:
Practice Address - Street 1:2900 1ST AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702
Practice Address - Country:US
Practice Address - Phone:304-526-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21398207R00000X, 208000000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000720339OtherWV BCBS
OH2691145Medicaid
WV1067482OtherWV DWC
WV1811128-000Medicaid
KY7100001570Medicaid
KY7100001570Medicaid
WV1811128-000Medicaid
OH2691145Medicaid
H99459Medicare UPIN