Healthcare Provider Details

I. General information

NPI: 1992744643
Provider Name (Legal Business Name): JOSEPH FROELICH SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 06/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 BRAEBURN DR
SALEM VA
24153-7357
US

IV. Provider business mailing address

1802 BRAEBURN DR
SALEM VA
24153-7357
US

V. Phone/Fax

Practice location:
  • Phone: 540-772-3485
  • Fax: 540-772-3486
Mailing address:
  • Phone: 540-772-3485
  • Fax: 540-772-3486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101043204
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: