Healthcare Provider Details

I. General information

NPI: 1457463663
Provider Name (Legal Business Name): DAMANEON SMITH DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5275 LEE HWY STE 303
ARLINGTON VA
22207-1619
US

IV. Provider business mailing address

5275 LEE HWY STE 303
ARLINGTON VA
22207-1619
US

V. Phone/Fax

Practice location:
  • Phone: 703-538-5111
  • Fax: 703-538-4193
Mailing address:
  • Phone: 703-538-5111
  • Fax: 703-538-4193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0103300902
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: