Provider Demographics
NPI:1881676047
Name:SMITH, MARK D II (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:SMITH
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1219 LEXINGTON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-2870
Mailing Address - Country:US
Mailing Address - Phone:336-475-7148
Mailing Address - Fax:336-475-7031
Practice Address - Street 1:1219 LEXINGTON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-2870
Practice Address - Country:US
Practice Address - Phone:336-475-7148
Practice Address - Fax:336-475-7031
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC97-01155208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11536OtherNC BCBS PROVIDER #
NC8911536Medicaid
G68238Medicare UPIN
2252654Medicare ID - Type UnspecifiedCIGNA MEDICARE PROVIDER #