Provider Demographics
NPI:1558391615
Name:SMARTH, CAROLE A (MD)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:A
Last Name:SMARTH
Suffix:
Gender:F
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 17334
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-1334
Mailing Address - Country:US
Mailing Address - Phone:703-443-6717
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:44084 RIVERSIDE PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-5102
Practice Address - Country:US
Practice Address - Phone:703-734-7530
Practice Address - Fax:703-858-2870
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101243111207R00000X, 208000000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1558391615Medicaid
VAP00690438OtherRR MEDICARE PIN
VAP00690438OtherRR MEDICARE PIN
VA1558391615Medicaid