Individual
MARK SAMUEL SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
16000 JOHNSTON MEMORIAL DR, FOURTH FLOOR, ABINGDON, VA 24211-7659
(276) 258-4050
(276) 258-4056
Mailing address
16000 JOHNSTON MEMORIAL DR, FOURTH FLOOR, ABINGDON, VA 24211-7659
(276) 258-4050
(276) 258-4056
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110004485
VA
363A00000X
Physician Assistant
2210
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1629321021
—
VA
01
—
P01334893
RR MEDICARE
VA
05
—
Q000164
—
TN
Enumeration date
10/23/2012
Last updated
02/23/2017
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