Provider Demographics
NPI:1578504130
Name:SMITH, KATHERINE M (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3909 SUNSET RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6667
Mailing Address - Country:US
Mailing Address - Phone:919-788-0505
Mailing Address - Fax:919-788-0519
Practice Address - Street 1:3909 SUNSET RIDGE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6667
Practice Address - Country:US
Practice Address - Phone:919-788-0505
Practice Address - Fax:919-788-0519
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9401046208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics