Basic Information
Provider Information | |||||||||
NPI: | 1427011311 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SAMPAT | ||||||||
FirstName: | SMITA | ||||||||
MiddleName: | NARESH | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 7200 | ||||||||
Address2: |   | ||||||||
City: | ROCKY MOUNT | ||||||||
State: | NC | ||||||||
PostalCode: | 278040200 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2529370200 | ||||||||
FaxNumber: | 2524510056 | ||||||||
Practice Location | |||||||||
Address1: | 921 N WINSTEAD AVE | ||||||||
Address2: |   | ||||||||
City: | ROCKY MOUNT | ||||||||
State: | NC | ||||||||
PostalCode: | 278048749 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2529370300 | ||||||||
FaxNumber: | 2529373108 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/11/2006 | ||||||||
LastUpdateDate: | 03/30/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036114715 | IL | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 2007-01452 | NC | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 1282007 | 01 | NC | UHC | OTHER | 221664 | 01 | NC | MEDCOST | OTHER | 1584220 | 01 | NC | CIGNA | OTHER | 5149052 | 01 | NC | AETNA | OTHER | 036114715 | 05 | IL |   | MEDICAID | 5908316 | 05 | NC |   | MEDICAID | 14646 | 01 | NC | BCBSNC | OTHER | 208959 | 01 | IL | GROUP | OTHER |