Healthcare Provider Details

I. General information

NPI: 1477750834
Provider Name (Legal Business Name): MARCUS JAMES SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 CHESAPEAKE AVE
NEWPORT NEWS VA
23607-6038
US

IV. Provider business mailing address

856 J CLYDE MORRIS BLVD SUITE A
NEWPORT NEWS VA
23601-1318
US

V. Phone/Fax

Practice location:
  • Phone: 757-534-9770
  • Fax: 757-928-8045
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0101250310
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: