Healthcare Provider Details

I. General information

NPI: 1396547089
Provider Name (Legal Business Name): ELLIOT SMITS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 DUKE MEDICINE CIR
DURHAM NC
27710-2000
US

IV. Provider business mailing address

432 MOORES LNDG
CHESAPEAKE VA
23322-7461
US

V. Phone/Fax

Practice location:
  • Phone: 855-855-6484
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: