Provider Demographics
NPI:1538123989
Name:SMITH, ELLISON LEON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLISON
Middle Name:LEON
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 VANDERBILT PARK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1700
Mailing Address - Country:US
Mailing Address - Phone:828-258-9533
Mailing Address - Fax:828-253-4434
Practice Address - Street 1:4 VANDERBILT PARK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1700
Practice Address - Country:US
Practice Address - Phone:828-258-9533
Practice Address - Fax:828-253-4434
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900353207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1780647578OtherGROUP NPI
NC2263571OtherMEDICARE PROVIDER NUMBER
NC1194NOtherBLUE CROSS
NC891194NMedicaid
NC891194NMedicaid
NC110186764Medicare PIN
NCG38450Medicare UPIN
NC0289230001Medicare NSC