Provider Demographics
NPI:1851674170
Name:SMITH, MARGO B (NP)
Entity Type:Individual
Prefix:
First Name:MARGO
Middle Name:B
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARGO
Other - Middle Name:T
Other - Last Name:BALTIMORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:7007 HARBOUR VIEW BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3657
Mailing Address - Country:US
Mailing Address - Phone:757-215-2784
Mailing Address - Fax:757-215-2728
Practice Address - Street 1:3253 TAYLOR RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-2452
Practice Address - Country:US
Practice Address - Phone:757-686-5673
Practice Address - Fax:757-686-8694
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169442363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV4143CMedicare PIN