Provider Demographics
NPI:1528376787
Name:SMITH, MICHAEL PATRICK (CPO)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:PATRICK
Last Name:SMITH
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 TECHNOLOGY DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-5974
Mailing Address - Country:US
Mailing Address - Phone:757-548-5656
Mailing Address - Fax:757-548-5657
Practice Address - Street 1:1521 TECHNOLOGY DRIVE
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5974
Practice Address - Country:US
Practice Address - Phone:757-548-5656
Practice Address - Fax:757-548-5657
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA072347OtherANTHEM
VA12167OtherOPTIMA
VA0648230002OtherMEDICARE ID-TYPE UNSPECIFIED
VA9110208Medicaid