Provider Demographics
NPI:1467470849
Name:SMITH, MELISSA O (DPM)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:O
Last Name:SMITH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5242 DAWES AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-1404
Mailing Address - Country:US
Mailing Address - Phone:703-578-3899
Mailing Address - Fax:703-578-8950
Practice Address - Street 1:5242 DAWES AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1404
Practice Address - Country:US
Practice Address - Phone:703-578-3899
Practice Address - Fax:703-578-8950
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300905213ES0103X
MD01382213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2022OtherBCBS
MD013618200Medicaid
MD7014474OtherAETNA
MD3262317OtherAETNA HMO
DCG02648C01Medicare PIN
MN2022OtherBCBS
VA5973700001Medicare NSC
MD7014474OtherAETNA
MD3262317OtherAETNA HMO