Individual
MR. MICHAEL PATRICK SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.P.O.
Contact information
Practice address
1521 TECHNOLOGY DRIVE, CHESAPEAKE, VA 23320-5974
(757) 548-5656
(757) 548-5657
Mailing address
1521 TECHNOLOGY DRIVE, CHESAPEAKE, VA 23320-5974
(757) 548-5656
(757) 548-5657
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
—
—
224P00000X
Prosthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0648230002
MEDICARE ID-TYPE UNSPECIFIED
VA
01
—
072347
ANTHEM
VA
01
—
12167
OPTIMA
VA
05
—
9110208
—
VA
Enumeration date
09/21/2010
Last updated
09/21/2010
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