Provider Demographics
NPI:1427011311
Name:SAMPAT, SMITA NARESH (MD)
Entity Type:Individual
Prefix:DR
First Name:SMITA
Middle Name:NARESH
Last Name:SAMPAT
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:PO BOX 7200
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-0200
Mailing Address - Country:US
Mailing Address - Phone:252-937-0200
Mailing Address - Fax:252-451-0056
Practice Address - Street 1:921 N WINSTEAD AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-8749
Practice Address - Country:US
Practice Address - Phone:252-937-0300
Practice Address - Fax:252-937-3108
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114715207R00000X
NC2007-01452207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1282007OtherUHC
NC221664OtherMEDCOST
NC1584220OtherCIGNA
NC5149052OtherAETNA
IL036114715Medicaid
NC5908316Medicaid
NC14646OtherBCBSNC
IL208959OtherGROUP
IL208959OtherGROUP
NC1282007OtherUHC
NCNC5601AMedicare PIN