Provider Demographics
NPI:1023115136
Name:SMITH, CAROLINE CLEMENTS (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:CLEMENTS
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 OLD FOREST DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-7341
Mailing Address - Country:US
Mailing Address - Phone:919-489-3248
Mailing Address - Fax:
Practice Address - Street 1:221 N GRAHAM HOPEDALE RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2971
Practice Address - Country:US
Practice Address - Phone:336-570-3739
Practice Address - Fax:336-570-1215
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8999999Medicaid
NCE33985Medicare UPIN
NC8999999Medicaid