Provider Demographics
NPI:1609930775
Name:SMITH, MICHAEL A (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16526 NC HIGHWAY 87 W
Mailing Address - Street 2:
Mailing Address - City:TAR HEEL
Mailing Address - State:NC
Mailing Address - Zip Code:28392-8608
Mailing Address - Country:US
Mailing Address - Phone:910-872-5700
Mailing Address - Fax:910-862-7256
Practice Address - Street 1:16526 NC HIGHWAY 87 W
Practice Address - Street 2:
Practice Address - City:TAR HEEL
Practice Address - State:NC
Practice Address - Zip Code:28392-8608
Practice Address - Country:US
Practice Address - Phone:910-872-5700
Practice Address - Fax:910-862-7256
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22054207Q00000X
OH091267207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCF45763Medicare UPIN