Provider Demographics
NPI:1538905013
Name:SMARSH, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SMARSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5852 POST CORNERS TRL APT M
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-6328
Mailing Address - Country:US
Mailing Address - Phone:724-650-5761
Mailing Address - Fax:
Practice Address - Street 1:24560 SOUTHPOINT DR STE 320
Practice Address - Street 2:
Practice Address - City:ALDIE
Practice Address - State:VA
Practice Address - Zip Code:20105-3504
Practice Address - Country:US
Practice Address - Phone:571-751-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110010740363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty