Provider Demographics
NPI:1215913603
Name:SMITH, DAVID N (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:N
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 MOCKSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2732
Mailing Address - Country:US
Mailing Address - Phone:704-210-5440
Mailing Address - Fax:704-210-5562
Practice Address - Street 1:423 LAUREL VALLEY WAY
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144
Practice Address - Country:US
Practice Address - Phone:704-630-9586
Practice Address - Fax:704-630-9586
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15186174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C81087Medicare UPIN