Provider Demographics
NPI:1205801040
Name:SMITH, BARTON P (MD)
Entity type:Individual
Prefix:DR
First Name:BARTON
Middle Name:P
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 SOUTH AVE
Mailing Address - Street 2:SUITE 4 A
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-3621
Mailing Address - Country:US
Mailing Address - Phone:804-524-2294
Mailing Address - Fax:804-524-0016
Practice Address - Street 1:930 SOUTH AVE
Practice Address - Street 2:SUITE 4 A
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-3621
Practice Address - Country:US
Practice Address - Phone:804-524-2294
Practice Address - Fax:804-524-0016
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037795208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007301201Medicaid
020013901Medicare PIN
VA020000403Medicare ID - Type Unspecified
VA007301201Medicaid
VAD73282Medicare UPIN