Provider Demographics
NPI:1902979727
Name:SMIRNIOTOPOULOS, THOMAS T (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:T
Last Name:SMIRNIOTOPOULOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:T
Other - Last Name:SMIRNIOTUPOULUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2000 NORTH BEAUREGARD ST
Mailing Address - Street 2:STE 360
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311
Mailing Address - Country:US
Mailing Address - Phone:703-924-9004
Mailing Address - Fax:703-924-9067
Practice Address - Street 1:2000 NORTH BEAUREGARD ST.
Practice Address - Street 2:STE 360
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311
Practice Address - Country:US
Practice Address - Phone:703-924-9004
Practice Address - Fax:703-924-9067
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031128207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA01018890Medicaid
VA5837227Medicaid
G02047AOSMedicare ID - Type Unspecified
B94852Medicare UPIN
DCB94852Medicare UPIN
G02047AMedicare Oscar/Certification