Provider Demographics
NPI:1972589927
Name:SMITH, MICHAEL W JR (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 12127
Mailing Address - Street 2:TIDEWATER DIAGNOSTIC IMAGING
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23612-2127
Mailing Address - Country:US
Mailing Address - Phone:757-867-6101
Mailing Address - Fax:757-867-6587
Practice Address - Street 1:3000 COLISEUM DR
Practice Address - Street 2:SENTARA CAREPLEX HOSPITAL
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5963
Practice Address - Country:US
Practice Address - Phone:757-736-1621
Practice Address - Fax:757-827-6748
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01012384652085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10005664OtherSENTARA
VAP00316605OtherRAILROAD MEDICARE
I44619Medicare UPIN
VAP00316605OtherRAILROAD MEDICARE