Provider Demographics
NPI:1356306625
Name:SMITH, ROBERT LAWRENCE (MD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LAWRENCE
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2876 GUARDIAN LANE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7327
Mailing Address - Country:US
Mailing Address - Phone:757-463-5240
Mailing Address - Fax:757-463-6572
Practice Address - Street 1:1060 FIRST COLONIAL RD
Practice Address - Street 2:SENTARA VIRGINIA BEACH GENERAL HOSPITAL
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3002
Practice Address - Country:US
Practice Address - Phone:757-395-8000
Practice Address - Fax:757-395-8653
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101016010207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA35158OtherSENTARA
VA270756OtherMPIPA OPTIMA CHOICE ALLIA
NC890686EMedicaid
VA013175OtherPRIORITY
VA013175OtherANTHEM
VA6656315Medicaid
VA35158OtherSENTARA