Provider Demographics
NPI:1558734269
Name:SMITH, VERA PAVLOVNA (PA)
Entity Type:Individual
Prefix:
First Name:VERA
Middle Name:PAVLOVNA
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:VERA
Other - Middle Name:PAVLOVNA
Other - Last Name:FILATOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:161 CLINT DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-7794
Mailing Address - Country:US
Mailing Address - Phone:614-866-8603
Mailing Address - Fax:614-866-8699
Practice Address - Street 1:161 CLINT DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-7794
Practice Address - Country:US
Practice Address - Phone:614-866-8603
Practice Address - Fax:614-866-8699
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004498363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant