Provider Demographics
NPI:1972574770
Name:SMITH, JENNIFER GADEYNE (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:GADEYNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:GADEYNE
Other - Last Name:MCCALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8220 MEADOWBRIDGE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-2339
Mailing Address - Country:US
Mailing Address - Phone:804-764-1253
Mailing Address - Fax:804-764-1259
Practice Address - Street 1:8220 MEADOWBRIDGE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2339
Practice Address - Country:US
Practice Address - Phone:804-764-1253
Practice Address - Fax:804-764-1259
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237011207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06115OtherGROUP PTAN
CAVADOOOMedicare UPIN