Provider Demographics
NPI:1679575070
Name:SMITH, JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
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 1:5722 GARDNER LN
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:VA
Mailing Address - Zip Code:22812-3614
Mailing Address - Country:US
Mailing Address - Phone:540-433-3344
Mailing Address - Fax:540-433-0031
Practice Address - Street 1:1751 ERICKSON AVE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-8555
Practice Address - Country:US
Practice Address - Phone:540-433-3344
Practice Address - Fax:540-433-0031
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101030257207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA070387OtherANTHEM ID#
VA005674191Medicaid
VA145670OtherSOUTHERN HEALTH ID#
VAD73362Medicare UPIN
VA080003116Medicare ID - Type Unspecified