Provider Demographics
NPI:1861439804
Name:SMITH, PATRICIA W (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:W
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2406 BLUE RIDGE RD
Mailing Address - Street 2:STE. 280
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6678
Mailing Address - Country:US
Mailing Address - Phone:919-256-2500
Mailing Address - Fax:919-256-2506
Practice Address - Street 1:2406 BLUE RIDGE RD
Practice Address - Street 2:STE. 280
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607
Practice Address - Country:US
Practice Address - Phone:919-256-2500
Practice Address - Fax:919-256-2506
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA016136174400000X
NC34466174400000X, 207WX0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC36686Medicare UPIN
NC2163545CMedicare PIN