Provider Demographics
NPI:1447216734
Name:SMITH, EDWARD PAUL (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:PAUL
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 1:190 CAMPUS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2872
Mailing Address - Country:US
Mailing Address - Phone:540-662-6135
Mailing Address - Fax:540-662-5845
Practice Address - Street 1:190 CAMPUS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2872
Practice Address - Country:US
Practice Address - Phone:540-662-6135
Practice Address - Fax:540-662-5845
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047458207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC00085OtherVA MEDICARE GROUP
WV000613355OtherWV BLUE SHIELD
08250500000OtherQUALCHOICE PROFESSIONAL
43939OtherSENTARA PROFESSIONAL
VAC00085OtherVA MEDICARE GROUP
43939OtherSENTARA PROFESSIONAL
43939OtherSENTARA PROFESSIONAL
F88645Medicare UPIN
08250500000OtherQUALCHOICE PROFESSIONAL
WV0078689000Medicaid