Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 0101243112 | VA |
N | 207R00000X | Internist | 21653 | WV |
N | 111NI0900X | Internist | 21653 | WV |
NPI | 1225127129 |
---|---|
Provider Name | Dr. Tamara Susan Smith |
First Address | Gainesville, VA 20155-4023 |
Second Address | Gainesville, VA 20155-4023 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 27/12/2012 |