Individual
MARK O'DELL SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
LEWIS GALE MEDICAL CENTER, 1900 ELECTRIC ROAD, SALEM, VA 24153
(540) 776-4000
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
0101-040639
VA
208600000X
Surgery Physician
2018-01853
NC
208600000X
Surgery Physician
Primary
40212
SC
2086S0102X
Surgical Critical Care Physician
0101-040639
VA
2086S0102X
Surgical Critical Care Physician
40212
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010018919
—
VA
05
—
1275505026
—
VA
01
—
40212
SC LICENSE #
—
05
—
402120
—
SC
01
—
SC97127628
MEDICARE PIN
SC
Enumeration date
02/06/2006
Last updated
06/01/2022
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