Provider Demographics
NPI:1801887344
Name:SMITH, DAVID MIDDLETON (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MIDDLETON
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2103 GRAVES MILL RD
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-2675
Mailing Address - Country:US
Mailing Address - Phone:434-316-7199
Mailing Address - Fax:434-316-6185
Practice Address - Street 1:2103 GRAVES MILL RD
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-2675
Practice Address - Country:US
Practice Address - Phone:434-316-7199
Practice Address - Fax:434-316-6185
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031023207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005613116Medicaid
VA452132OtherANTHEM/BC/BS
VA300825OtherSOUTHERN HEALTH
VA080179876OtherRAILROAD MEDICARE
VA5234699OtherCIGNA
VA541901162001OtherPCHP
VA0134585OtherUNITED HEALTHCARE