Provider Demographics
NPI:1730284597
Name:SMITH, CAROLYN V (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:V
Last Name:SMITH
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Gender:F
Credentials:MD
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Mailing Address - Street 1:2285 EXECUTIVE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505-4810
Mailing Address - Country:US
Mailing Address - Phone:859-294-0130
Mailing Address - Fax:859-294-0236
Practice Address - Street 1:2285 EXECUTIVE DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505
Practice Address - Country:US
Practice Address - Phone:859-294-0130
Practice Address - Fax:859-294-0236
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2013-09-27
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Provider Licenses
StateLicense IDTaxonomies
KY31089208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY168568Medicare UPIN