Provider Demographics
NPI:1639282692
Name:SMITH, LORI D (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:D
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4705 UNIVERSITY DR BLDG 700
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3489
Mailing Address - Country:US
Mailing Address - Phone:919-748-4899
Mailing Address - Fax:866-538-4716
Practice Address - Street 1:1824 E ARBORS DR STE 350
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-2693
Practice Address - Country:US
Practice Address - Phone:980-580-0588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010049412083B0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5904509Medicaid
NC808266OtherPARTNERS MEDICARE CHOICE
NC191794OtherMEDCOST
NC7118189OtherAETNA
NC143EWOtherBXBS
NC1639282692Medicaid
NC232009OtherMEDICARE PTAN, GROUP
NCNCA278BMedicare PIN
NCNCA278EMedicare PIN
NCNCA278GMedicare PIN
NC2056340AMedicare PIN
NC7118189OtherAETNA
NC191794OtherMEDCOST
NC143EWOtherBXBS
NC5904509Medicaid
NCNCA278CMedicare PIN