Healthcare Provider Details

I. General information

NPI: 1033353768
Provider Name (Legal Business Name): MAIRIN SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARTHA JEFFERSON DR
CHARLOTTESVILLE VA
22911-4668
US

IV. Provider business mailing address

309 MONTICELLO RD
CHARLOTTESVILLE VA
22902-5742
US

V. Phone/Fax

Practice location:
  • Phone: 434-654-7154
  • Fax:
Mailing address:
  • Phone: 434-960-7352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number252538
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101253809
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: