MEDICARE: DAMANEON SMITH DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	0103300902	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	6289370001	OTHER	VA	DME
3	P00831471	OTHER	VA	MCR-RR

General Provider Information

NPI Number	:	1457463663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAMANEON SMITH DPM

Provider Business Mailing Address
First Line	:	5275 LEE HWY STE 303
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22207-1619
Country	:	US
Telephone Number	:	703-538-5111
Fax Number	:	703-538-4193

Provider Business Practice Location Address
First Line	:	5275 LEE HWY STE 303
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22207-1619
Country	:	US
Telephone Number	:	703-538-5111
Fax Number	:	703-538-4193

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	11/28/2012

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Directions to “ DAMANEON SMITH DPM” Practice Location

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