Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 0101050297 | VA |
N | 2080N0001X | Neonatal-Perinatal Doctor | 0101050297 | VA |
N | 2080P0204X | Pediatric Emergency Doctor | 0101050297 | VA |
NPI | 1003857798 |
---|---|
Provider Name | Michael Lee Smith |
First Address | Baltimore, MD 21279-0137 |
Second Address | Norfolk, VA 23507-1910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2006 |
Last Update Date | 10/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0019147160001 | (05) | PA |
006711979 | (05) | VA |
1000034823 | (05) | DE |
790536X | (05) | NC |
G15981 | (02) |