Provider Demographics
NPI:1801987169
Name:SMITH, CLIFFORD LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:LAWRENCE
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:12720 MCMANUS BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-4414
Mailing Address - Country:US
Mailing Address - Phone:757-947-3170
Mailing Address - Fax:757-947-3180
Practice Address - Street 1:12720 MCMANUS BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4414
Practice Address - Country:US
Practice Address - Phone:757-947-3170
Practice Address - Fax:757-947-3180
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2022-01-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HI9422208600000X
VA0101253226208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10716OtherGROUP PTAN