Individual
DR. THOMAS LARRY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2200 OPITZ BLVD, SUITE 100, WOODBRIDGE, VA 22191-3321
(703) 492-4140
(703) 991-8104
Mailing address
2200 OPITZ BLVD, SUITE 100, WOODBRIDGE, VA 22191-3321
(703) 492-4140
(703) 991-8104
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
0101052153
VA
207N00000X
Dermatology Physician
Primary
101052153
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5900409
—
VA
Enumeration date
03/31/2006
Last updated
02/06/2015
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