MEDICARE: DR. JENNIFER GADEYNE SMITH MD

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	207R00000X	Internal Medicine Physician	0101237011	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C06115	OTHER	VA	GROUP PTAN

General Provider Information

NPI Number	:	1972574770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER GADEYNE SMITH MD

Provider Business Mailing Address
First Line	:	8220 MEADOWBRIDGE RD
Second Line	:	SUITE 203
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-2339
Country	:	US
Telephone Number	:	804-764-1253
Fax Number	:	804-764-1259

Provider Business Practice Location Address
First Line	:	8220 MEADOWBRIDGE RD
Second Line	:	SUITE 203
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-2339
Country	:	US
Telephone Number	:	804-764-1253
Fax Number	:	804-764-1259

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	03/21/2012

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