Healthcare Provider Details

I. General information

NPI: 1891773578
Provider Name (Legal Business Name): ROBERT KEVIN SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 JAHNKE RD SUITE 280
RICHMOND VA
23225-4017
US

IV. Provider business mailing address

600 JOE BROOKE LN
MANAKIN SABOT VA
23103-3168
US

V. Phone/Fax

Practice location:
  • Phone: 804-272-5508
  • Fax: 804-323-7564
Mailing address:
  • Phone: 804-784-8074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number0101046176
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number0101046176
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: