Provider Demographics
NPI:1609066158
Name:KAREN L.SMITH MD, PA
Entity Type:Organization
Organization Name:KAREN L.SMITH MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LINNEAR
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-904-1695
Mailing Address - Street 1:929 WEST PROSPECT AVENUE
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-6197
Mailing Address - Country:US
Mailing Address - Phone:910-904-1695
Mailing Address - Fax:901-904-1767
Practice Address - Street 1:929 WEST PROSPECT AVENUE
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-6197
Practice Address - Country:US
Practice Address - Phone:910-904-1695
Practice Address - Fax:901-904-1767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
NCNC33894261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8977236Medicaid
NCF26942Medicare UPIN
NC2170576HMedicare PIN