Provider Demographics
NPI:1770318586
Name:SMITH, SEAN GABRIEL (NREMT)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:GABRIEL
Last Name:SMITH
Suffix:
Gender:M
Credentials:NREMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12611 FREDERICKSBURG TPKE
Mailing Address - Street 2:
Mailing Address - City:WOODFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22580-2863
Mailing Address - Country:US
Mailing Address - Phone:817-470-8722
Mailing Address - Fax:
Practice Address - Street 1:12611 FREDERICKSBURG TPKE
Practice Address - Street 2:
Practice Address - City:WOODFORD
Practice Address - State:VA
Practice Address - Zip Code:22580-2863
Practice Address - Country:US
Practice Address - Phone:817-470-8722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAB202404586146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate