Organization
NORTHSIDE PEDIATRICS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAKEITA LYNNE SMITH MD (PHYSICIAN)
(804) 432-4631
Entity
Organization
Contact information
Practice address
2008 BREMO RD, SUITE 100, RICHMOND, VA 23226-2443
(804) 288-0814
(877) 331-0645
Mailing address
PO BOX 28690, RICHMOND, VA 23228-8690
(804) 432-4631
(877) 331-0645
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101231186
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101231186
VA LICENSE NUMBER
VA
05
—
010167175
—
VA
01
—
1710963582
LAKEITA L. SMITH'S NPI
—
Enumeration date
07/19/2006
Last updated
05/20/2009
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