Provider Demographics
NPI:1669403382
Name:SMITH, M. GEOFFREY (MD)
Entity type:Individual
Prefix:DR
First Name:M. GEOFFREY
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:326 TAYLOR DR
Mailing Address - Street 2:DANVILLE HEALTH DEPT
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4023
Mailing Address - Country:US
Mailing Address - Phone:434-799-5190
Mailing Address - Fax:434-799-5022
Practice Address - Street 1:326 TAYLOR DR
Practice Address - Street 2:DANVILLE HEALTH DEPARTMENT
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4023
Practice Address - Country:US
Practice Address - Phone:434-799-5190
Practice Address - Fax:434-799-5022
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012221882083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPS000Medicare UPIN