Provider Demographics
NPI:1639282692
Name:SMITH, LORI D (MD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:D
Last Name:SMITH
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:LORI
Other - Middle Name:D
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1480 CONCORD PKWY N STE 350
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-0121
Mailing Address - Country:US
Mailing Address - Phone:704-343-5005
Mailing Address - Fax:704-519-2653
Practice Address - Street 1:1480 CONCORD PKWY N STE 350
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-0121
Practice Address - Country:US
Practice Address - Phone:704-343-5005
Practice Address - Fax:704-519-2653
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-00920207RB0002X, 2083B0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5904509Medicaid
NC808266OtherPARTNERS MEDICARE CHOICE
NC191794OtherMEDCOST
NC7118189OtherAETNA
NC143EWOtherBXBS
NC1639282692Medicaid
NC232009OtherMEDICARE PTAN, GROUP
NCNCA278BMedicare PIN
NCNCA278EMedicare PIN
NCNCA278GMedicare PIN
NC2056340AMedicare PIN
NC7118189OtherAETNA
NC191794OtherMEDCOST
NC143EWOtherBXBS
NC5904509Medicaid
NCNCA278CMedicare PIN