Provider Demographics
NPI:1487323382
Name:SMITH, RONALD CORNELL II
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:CORNELL
Last Name:SMITH
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 WYNN STREET
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-3140
Mailing Address - Country:US
Mailing Address - Phone:757-531-6295
Mailing Address - Fax:757-488-5649
Practice Address - Street 1:112 WYNN STREET
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-3140
Practice Address - Country:US
Practice Address - Phone:757-531-6295
Practice Address - Fax:757-488-5649
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company