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General NPI Number Information
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NPI Number | 1225127129
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Entity Type | Individual
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Provider Name | TAMARA SUSAN SMITH M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 14535 JOHN MARSHALL HWY, SUITE 212
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City | GAINESVILLE
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State | VA
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Zip | 20155-4025
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Country | US
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Telephone | 571-248-0245
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Fax | 571-248-0241
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Provider Business Mailing Address
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Address Line | 224 D CORNWALL STREET NW STE 403
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City | LEESBURG
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State | VA
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Zip | 20176-2704
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Country | US
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Telephone | 703-737-6010
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Fax | 703-443-8643
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101243112
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 21653
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 0101243112
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License Number State | VA
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