Provider Demographics
NPI:1336275965
Name:SMID, JOHN ANDRE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANDRE
Last Name:SMID
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 1:4601 PARK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3239
Mailing Address - Country:US
Mailing Address - Phone:704-323-2000
Mailing Address - Fax:
Practice Address - Street 1:1604 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-5524
Practice Address - Country:US
Practice Address - Phone:704-323-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601074207X00000X
SC18870207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT28762Medicaid
SCT28761Medicaid
NC8977209Medicaid
NC77209OtherNC BCBS
NC2225814Medicare ID - Type UnspecifiedNC MEDICARE
SCG287624285Medicare ID - Type UnspecifiedSC MEDICARE
NC2225814AMedicare PIN
SCT28761Medicaid
SCG287629016Medicare PIN
G28762Medicare UPIN
NC0397730032Medicare NSC