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NPI Code Detail

MEDICARE: MR. MICHAEL PATRICK SMITH C.P.O.

MEDICARE: MR. MICHAEL PATRICK SMITH C.P.O.
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
1222Z00000XOrthotist
2224P00000XProsthetist

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
30648230002OTHERVAMEDICARE ID-TYPE UNSPECIFIED

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1072347OTHERVAANTHEM
212167OTHERVAOPTIMA
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528376787
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL PATRICK SMITH C.P.O.
Provider Business Mailing Address
First Line : 1521 TECHNOLOGY DRIVE
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23320-5974
Country : US
Telephone Number : 757-548-5656
Fax Number : 757-548-5657
Provider Business Practice Location Address
First Line : 1521 TECHNOLOGY DRIVE
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23320-5974
Country : US
Telephone Number : 757-548-5656
Fax Number : 757-548-5657
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2010
Last Update Date : 09/21/2010

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