Provider Demographics
NPI:1538125513
Name:SMITH, RAY M III (MD)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:M
Last Name:SMITH
Suffix:III
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 758994
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-6412
Mailing Address - Country:US
Mailing Address - Phone:757-889-5068
Mailing Address - Fax:
Practice Address - Street 1:150 KINGSLEY LANE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505
Practice Address - Country:US
Practice Address - Phone:757-889-5146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034088207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA66-2525-8Medicaid
220000251Medicare PIN
220013154Medicare PIN
E28330Medicare UPIN