Provider Demographics
NPI:1972162535
Name:JEROME G. SMITH, MD PC
Entity type:Organization
Organization Name:JEROME G. SMITH, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:G
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-418-3856
Mailing Address - Street 1:4788 FINLAY ST STE 1
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23231-2855
Mailing Address - Country:US
Mailing Address - Phone:804-418-3856
Mailing Address - Fax:804-418-3868
Practice Address - Street 1:4788 FINLAY ST STE 1
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23231-2855
Practice Address - Country:US
Practice Address - Phone:804-418-3856
Practice Address - Fax:804-418-3868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-07
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty