Provider Demographics
NPI:1790736775
Name:SMITH, GREGORY E (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:E
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 GREEN VALLEY ROAD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408
Mailing Address - Country:US
Mailing Address - Phone:336-282-4840
Mailing Address - Fax:336-282-4660
Practice Address - Street 1:600 GREEN VALLEY ROAD
Practice Address - Street 2:SUITE 304
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408
Practice Address - Country:US
Practice Address - Phone:336-282-4840
Practice Address - Fax:336-282-4660
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC25438207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC77664OtherBCBS
NCP00969102OtherRAILROAD-MEDICARE
VA5714630Medicaid
NC8977664Medicaid
C86499Medicare UPIN
210525AMedicare ID - Type Unspecified