Healthcare Provider Details

I. General information

NPI: 1710256094
Provider Name (Legal Business Name): LAVONE ANDREA SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5875 BREMO RD STE 400C
RICHMOND VA
23226-1928
US

IV. Provider business mailing address

PO BOX 639969
CINCINNATI OH
45263-9969
US

V. Phone/Fax

Practice location:
  • Phone: 804-287-3550
  • Fax: 804-281-7840
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP1230
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2017-00674
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101276794
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number2017-00674
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2017-00674
License Number StateNC
# 6
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number0101276794
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: