Provider Demographics
NPI:1689732570
Name:SMITH, PETER J (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:SMITH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1 HARBOR CT
Mailing Address - Street 2:APT 22 A
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-3825
Mailing Address - Country:US
Mailing Address - Phone:757-289-9333
Mailing Address - Fax:
Practice Address - Street 1:3636 HIGH ST
Practice Address - Street 2:MARYVIEW BEHAVIORAL HEALTH
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3236
Practice Address - Country:US
Practice Address - Phone:757-398-2361
Practice Address - Fax:757-393-9343
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2011-11-03
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Provider Licenses
StateLicense IDTaxonomies
CT210852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC59741Medicare UPIN