Provider Demographics
NPI:1457345910
Name:SMITH, BRADLEY TODD (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:TODD
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:PO BOX 5105
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-5100
Mailing Address - Country:US
Mailing Address - Phone:919-220-5255
Mailing Address - Fax:
Practice Address - Street 1:1803 FOREST HILLS RD W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3412
Practice Address - Country:US
Practice Address - Phone:252-243-9629
Practice Address - Fax:252-243-0915
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000314207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCD4898OtherMEDCOST
NC1364XOtherBCBSNC
NCP00174692OtherRAILROAD MEDICARE
NC7040139OtherCIGNA HEALTHCARE
NC7040139OtherCIGNA HEALTHCARE
NCD4898OtherMEDCOST
NCP00174692OtherRAILROAD MEDICARE