Provider Demographics
NPI:1700829132
Name:SMITH, CAROL M (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:40 HURLEY AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3739
Mailing Address - Country:US
Mailing Address - Phone:845-338-5600
Mailing Address - Fax:845-338-3058
Practice Address - Street 1:40 HURLEY AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3739
Practice Address - Country:US
Practice Address - Phone:845-338-5600
Practice Address - Fax:845-338-3058
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2010-12-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY163320-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE87304Medicare UPIN
NYW4K811Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER