Provider Demographics
NPI:1780610782
Name:SMITH, MATTHEW ALAN (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ALAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4299 SAN FELIPE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-2916
Mailing Address - Country:US
Mailing Address - Phone:832-476-3900
Mailing Address - Fax:832-476-3990
Practice Address - Street 1:5801 BREMO ROAD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1907
Practice Address - Country:US
Practice Address - Phone:804-285-0620
Practice Address - Fax:804-285-0726
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238089207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00226604OtherRAILROAD MEDICARE
007747I87Medicare PIN
P00226604OtherRAILROAD MEDICARE