Provider Demographics
NPI:1275521973
Name:SMITH, TERESA A (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1688 E ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5871
Mailing Address - Country:US
Mailing Address - Phone:252-353-1464
Mailing Address - Fax:252-353-1272
Practice Address - Street 1:1688 E ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5871
Practice Address - Country:US
Practice Address - Phone:252-353-1464
Practice Address - Fax:252-353-1272
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39329207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2156385DMedicare ID - Type Unspecified
E66877Medicare UPIN