Provider Demographics
NPI:1841350915
Name:SMIGRODZKI, RAFAL MAREK (MD)
Entity type:Individual
Prefix:
First Name:RAFAL
Middle Name:MAREK
Last Name:SMIGRODZKI
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7050 GLENHAVEN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8981
Mailing Address - Country:US
Mailing Address - Phone:434-249-4381
Mailing Address - Fax:940-301-3881
Practice Address - Street 1:7050 GLENHAVEN RIDGE DR
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8981
Practice Address - Country:US
Practice Address - Phone:434-249-4381
Practice Address - Fax:940-301-3881
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-019222084N0400X
ND98992084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13378Medicaid
MN817947600OtherMN MA
HP49894OtherHEALTHPARTNERS
1043499OtherPREFERREDONE
215G6SMOtherMN BCBS
25343OtherND BCBS
0500502OtherMEDICA
H68751Medicare UPIN
ND13378Medicaid