Provider Demographics
NPI:1538905898
Name:SMITH-GRAHAM, CHARMAINE (RESPIRATORY THERAPIS)
Entity type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:
Last Name:SMITH-GRAHAM
Suffix:
Gender:F
Credentials:RESPIRATORY THERAPIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7617 POCOSHOCK WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-6482
Mailing Address - Country:US
Mailing Address - Phone:804-767-9583
Mailing Address - Fax:
Practice Address - Street 1:7617 POCOSHOCK WAY
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-6482
Practice Address - Country:US
Practice Address - Phone:347-866-6980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-06
Last Update Date:2024-10-02
Deactivation Date:2024-09-04
Deactivation Code:
Reactivation Date:2024-10-02
Provider Licenses
StateLicense IDTaxonomies
VA01170055722278G1100X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No2278G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGeneral CareGroup - Single Specialty