Healthcare Provider Details

I. General information

NPI: 1164480612
Provider Name (Legal Business Name): JAMES DAVID SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR SENTARA NORFOLK GENERAL HOSPITAL PATH DEPT
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

PO BOX 20452
COLUMBUS OH
43220-0452
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-3221
  • Fax: 757-388-3799
Mailing address:
  • Phone: 614-442-2406
  • Fax: 614-442-2410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number0101233926
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number0101233926
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: