Provider Demographics
NPI:1942280250
Name:SMITH, JOHN JAMES (MD,)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JAMES
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 1:1510 COLONIAL CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-1439
Mailing Address - Country:US
Mailing Address - Phone:703-448-8800
Mailing Address - Fax:703-448-8515
Practice Address - Street 1:17 WESTERN MARYLAND PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5146
Practice Address - Country:US
Practice Address - Phone:301-733-1477
Practice Address - Fax:301-733-7758
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00611012085R0202X
CODR427912085N0700X
DEC100074722085R0202X
OH350843382085R0202X
PAMD4250842085R0202X
VA2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001128Medicaid
PA10093112Medicaid
DE1000033555Medicaid
PA10181502002Medicare PIN
OH4139284Medicare PIN
MD193MI172Medicare PIN
VA10118921Medicare PIN
DE015130M06Medicare PIN
PA083071N7WMedicare PIN
G67352Medicare UPIN
OH4139283Medicare PIN
OH4139282Medicare PIN
VA10093066Medicare PIN
PA10093112Medicaid
WV3810001128Medicaid