Provider Demographics
NPI:1730108259
Name:SMITH, RALPH SILAS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:SILAS
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4503 KANAWHA AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1834
Mailing Address - Country:US
Mailing Address - Phone:304-546-7253
Mailing Address - Fax:304-925-3653
Practice Address - Street 1:1219 OHIO AVE
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-3019
Practice Address - Country:US
Practice Address - Phone:304-344-0349
Practice Address - Fax:304-344-0384
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2020-03-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV101112084A0401X, 2084P0800X, 2084P0802X, 2084P0804X, 2084F0202X
FLME 185262084P0800X
CAG211562084P0800X
OH35-0300602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0116636000Medicaid
WVA71892Medicare UPIN
SM0577952Medicare ID - Type Unspecified