Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 0101046089 | VA |
NPI | 1023046208 |
---|---|
Provider Name | Pamela B Smith |
First Address | Chesapeake, VA 23321-5533 |
Second Address | Chesapeake, VA 23321-5533 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 25/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6211194 | (05) | VA |
E89450 | (02) | VA |