Healthcare Provider Details

I. General information

NPI: 1447216734
Provider Name (Legal Business Name): EDWARD PAUL SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 CAMPUS BLVD SUITE 200
WINCHESTER VA
22601-2872
US

IV. Provider business mailing address

190 CAMPUS BLVD SUITE 200
WINCHESTER VA
22601-2872
US

V. Phone/Fax

Practice location:
  • Phone: 540-662-6135
  • Fax: 540-662-5845
Mailing address:
  • Phone: 540-662-6135
  • Fax: 540-662-5845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101047458
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: