Provider Demographics
NPI:1639125438
Name:SMITH, RICHARD A (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:SMITH
Suffix:
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 1:29 OLD FARM RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-5656
Mailing Address - Country:US
Mailing Address - Phone:434-822-0977
Mailing Address - Fax:434-822-0978
Practice Address - Street 1:142 S MAIN ST
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-2922
Practice Address - Country:US
Practice Address - Phone:434-799-3742
Practice Address - Fax:434-799-3857
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101036877207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005885868Medicaid
AS3196044OtherDEA REG
D71880Medicare UPIN
00V328D82Medicare ID - Type UnspecifiedGRP C08682
VA005885868Medicaid