Healthcare Provider Details

I. General information

NPI: 1578528030
Provider Name (Legal Business Name): HAROLD STEVEN SMUCKLER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF VETERANS AFFAIRS, PRIMARY CARE 100 EMANCIPATION LANE
HAMPTON VA
23667
US

IV. Provider business mailing address

114 PAMUNKEY TURN
YORKTOWN VA
23693-2740
US

V. Phone/Fax

Practice location:
  • Phone: 757-722-9961
  • Fax: 757-723-3126
Mailing address:
  • Phone: 757-722-9961
  • Fax: 757-723-3126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102036984
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: