Provider Demographics
NPI:1023087566
Name:SMITH, CAROLE J (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:28 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-1937
Mailing Address - Country:US
Mailing Address - Phone:781-826-8065
Mailing Address - Fax:781-826-8043
Practice Address - Street 1:28 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359-1937
Practice Address - Country:US
Practice Address - Phone:781-826-8065
Practice Address - Fax:781-826-8043
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA220572207Q00000X
RIMD15209207Q00000X
NY282496207Q00000X
MEMD20873207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA15512OtherHARVARD PILGRIM
MA469458OtherTUFTS HEALTH PLAN
MA2071380Medicaid
MAJ27786OtherBLUE CROSS BLUE SHIELD
MAI10311Medicare UPIN
MAAA15512OtherHARVARD PILGRIM