MEDICARE: GERRY NIEMAN SMITH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	0101049815	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	400020904	OTHER	VA	IRS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215991377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERRY NIEMAN SMITH MD

Provider Business Mailing Address
First Line	:	548 ALLENS MILL RD
Second Line	:
City	:	GRAFTON
State	:	VA
Zip	:	23692-2240
Country	:	US
Telephone Number	:	757-496-2325
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 FIRST COLONIAL RD STE 206
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2418
Country	:	US
Telephone Number	:	757-496-2325
Fax Number	:	757-496-1942

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	03/06/2023

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