Provider Demographics
NPI:1558788034
Name:LANGE SMITH, LAUREN THERESE (MD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:THERESE
Last Name:LANGE SMITH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 KILDAIRE PARK DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-8161
Mailing Address - Country:US
Mailing Address - Phone:919-235-6507
Mailing Address - Fax:919-235-6536
Practice Address - Street 1:110 KILDAIRE PARK DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8162
Practice Address - Country:US
Practice Address - Phone:919-235-6505
Practice Address - Fax:919-235-6535
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2024-02951208000000X
OH35.141362208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1558788034Medicaid
OH0433415Medicaid
NC1558788034Medicaid