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General NPI Number Information
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NPI Number | 1275505026
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Entity Type | Individual
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Provider Name | MARK O'DELL SMITH M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/06/2006
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Last Update Date | 06/01/2022
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Provider Practice Location Address
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Address Line | LEWIS GALE MEDICAL CENTER 1900 ELECTRIC ROAD
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City | SALEM
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State | VA
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Zip | 24153
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Country | US
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Telephone | 540-776-4000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 743070
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City | ATLANTA
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State | GA
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Zip | 30374-3070
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Country | US
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Telephone | 864-560-4304
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Fax | 864-560-4413
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 2018-01853
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 0101-040639
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 40212
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 0101-040639
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 40212
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License Number State | SC
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