Basic Information
| Provider Information | |||||||||
| NPI: | 1548559081 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | ELLIOT | ||||||||
| MiddleName: | Z | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 238 PEBBLE BEACH CT | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229013246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109136920 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | UVA HOSPITAL | ||||||||
| Address2: | 1215 LEE ST. | ||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229080001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349240000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2011 | ||||||||
| LastUpdateDate: | 10/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 0101255764 | VA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 0101255764 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 0101255764 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.