Provider Demographics
NPI:1295720696
Name:SMIR, BASSAM N (MD)
Entity type:Individual
Prefix:
First Name:BASSAM
Middle Name:N
Last Name:SMIR
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:PO BOX 13508
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-3508
Mailing Address - Country:US
Mailing Address - Phone:336-271-4930
Mailing Address - Fax:336-271-8466
Practice Address - Street 1:501 N ELAM AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1118
Practice Address - Country:US
Practice Address - Phone:336-271-4930
Practice Address - Fax:336-271-8466
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G32990Medicare UPIN
2279989Medicare PIN