Healthcare Provider Details

I. General information

NPI: 1841428729
Provider Name (Legal Business Name): LAUREN LEE SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 CHILDRENS LN
NORFOLK VA
23507-1910
US

IV. Provider business mailing address

601 CHILDRENS LN
NORFOLK VA
23507-1971
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-8255
  • Fax:
Mailing address:
  • Phone: 757-668-8255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number0101255556
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: