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Organization
CLEANSLATE MEDICAL GROUP OF VIRGINIA, LLC
Active
Organization
CLEANSLATE MEDICAL GROUP OF VIRGINIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW PHILIP SMOLAREK (CFO)
(412) 999-5188
Entity
Organization
Contact information
Practice address
8220 MEADOWBRIDGE RD STE 310, MECHANICSVILLE, VA 23116-2340
(804) 417-0120
(804) 277-3029
Mailing address
8 CADILLAC DR STE 180, BRENTWOOD, TN 37027-5393
(615) 425-0220
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
NULL
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
12/16/2018
Last updated
07/03/2024
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