MEDICARE: PHILIP SMITH M.D.

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	2084P0800X	Psychiatry Physician	MD034477	DC
2	2084P0804X	Child & Adolescent Psychiatry Physician	0101058192	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0101058192	OTHER	VA	MEDICAL LICENSE
2	MD034477	OTHER	DC	MEDICAL LICENSE

General Provider Information

NPI Number	:	1780608984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP SMITH M.D.

Provider Business Mailing Address
First Line	:	8221 WILLOW OAKS CORPORATE DR
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-4512
Country	:	US
Telephone Number	:	703-207-7818
Fax Number	:	703-653-6692

Provider Business Practice Location Address
First Line	:	8221 WILLOW OAKS CORPORATE DR
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-4512
Country	:	US
Telephone Number	:	703-207-7818
Fax Number	:	703-653-6692

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	12/11/2016

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