Provider Demographics
NPI:1518986652
Name:SMART, CARL ANDRE (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:ANDRE
Last Name:SMART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-2154
Mailing Address - Fax:704-316-2159
Practice Address - Street 1:2000 WELLNESS BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-3354
Practice Address - Country:US
Practice Address - Phone:704-316-2154
Practice Address - Fax:704-316-2159
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9400640174400000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN00640Medicaid
NC8977165Medicaid
NCF31098Medicare UPIN
NCNCW018AMedicare UPIN
NC2199937PMedicare PIN