Individual
TARA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8233 OLD COURTHOUSE RD STE 170, VIENNA, VA 22182-3833
(703) 556-9318
Mailing address
8233 OLD COURTHOUSE RD STE 170, VIENNA, VA 22182-3833
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110005062
VA
Other
Enumeration date
02/17/2016
Last updated
02/17/2016
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