Healthcare Provider Details

I. General information

NPI: 1043284672
Provider Name (Legal Business Name): LORI V SMITHSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 WILLOW LAWN DR STE 117
RICHMOND VA
23230-3421
US

IV. Provider business mailing address

1508 WILLOW LAWN DR STE 117
RICHMOND VA
23230-3421
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-8102
  • Fax: 804-282-3744
Mailing address:
  • Phone: 804-288-8102
  • Fax: 804-282-3744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number0101033670
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number0101033670
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number0101033670
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number0101033670
License Number StateVA
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101033670
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number0101033670
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number0101033670
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: