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
—
—
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
12/16/2018
Last updated
07/03/2024
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