Provider Demographics
NPI:1649555251
Name:SMOCK, COREY H (PA-C)
Entity type:Individual
Prefix:MR
First Name:COREY
Middle Name:H
Last Name:SMOCK
Suffix:
Gender:M
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:2900 LAMB CIR
Mailing Address - Street 2:SUITE L-760
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-6344
Mailing Address - Country:US
Mailing Address - Phone:540-731-2436
Mailing Address - Fax:540-731-2439
Practice Address - Street 1:2900 LAMB CIR
Practice Address - Street 2:SUITE L-760
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6344
Practice Address - Country:US
Practice Address - Phone:540-731-2436
Practice Address - Fax:540-731-2439
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110004224363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1649555251Medicaid
VA541586601118OtherTRICARE
VA1649555251OtherSOUTHERN HEALTH/CARENET/CARELINK/COVENTRY
VA1649555251OtherUMWA
VA1649555251OtherAMERIGROUP
VA1649555251OtherHUMANA MEDICARE
VA495870OtherANTHEM MEDIGAP
VA1649555251OtherOPTIMA HEALTHCARE
VAP01235710OtherRAILROAD MEDICARE
VA1649555251OtherAETNA
VA495870OtherANTHEM MEDIGAP