Provider Demographics
NPI:1194232058
Name:SMITH, DAREN EDWARD
Entity type:Individual
Prefix:
First Name:DAREN
Middle Name:EDWARD
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 MAPLE GROVE DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-8917
Mailing Address - Country:US
Mailing Address - Phone:540-270-5588
Mailing Address - Fax:
Practice Address - Street 1:6204 PLANK RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-6238
Practice Address - Country:US
Practice Address - Phone:540-507-7966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-01
Last Update Date:2018-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
146D00000X
VAB201400319207PE0004X, 146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB201400319OtherVIRGINIA OFFICE OF EMERGENCY MEDICAL SERVICES