Provider Demographics
NPI:1013015080
Name:SMITH, THEDIA J (MD)
Entity Type:Individual
Prefix:
First Name:THEDIA
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:733 VOLVO PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-1609
Mailing Address - Country:US
Mailing Address - Phone:757-547-5851
Mailing Address - Fax:888-371-4920
Practice Address - Street 1:733 VOLVO PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1609
Practice Address - Country:US
Practice Address - Phone:757-547-5851
Practice Address - Fax:888-371-4920
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2013-08-14
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Provider Licenses
StateLicense IDTaxonomies
VA0101046052208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010346045Medicaid
VA010346045Medicaid