Healthcare Provider Details

I. General information

NPI: 1467470849
Provider Name (Legal Business Name): MELISSA O SMITH D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 12/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5242 DAWES AVE
ALEXANDRIA VA
22311-1404
US

IV. Provider business mailing address

5242 DAWES AVE
ALEXANDRIA VA
22311-1404
US

V. Phone/Fax

Practice location:
  • Phone: 703-578-3899
  • Fax: 703-578-8950
Mailing address:
  • Phone: 703-578-3899
  • Fax: 703-578-8950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103300905
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: