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NPI Code Detail

MEDICARE: RODERICK SMITH

MEDICARE: RODERICK SMITH
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
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1588184006
Entity Type Code : Individual
Provider Name (Legal Business Name) : RODERICK SMITH
Provider Business Mailing Address
First Line : 2 PIDGEON HILL DR STE 400
Second Line :
City : STERLING
State : VA
Zip : 20165-6129
Country : US
Telephone Number : 703-430-7090
Fax Number : 703-444-9878
Provider Business Practice Location Address
First Line : 2 PIDGEON HILL DR STE 400
Second Line :
City : STERLING
State : VA
Zip : 20165-6129
Country : US
Telephone Number : 703-430-7090
Fax Number : 703-444-9878
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2017
Last Update Date : 07/21/2022

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Directions to “ RODERICK SMITH ” Practice Location

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