Healthcare Provider Details

I. General information

NPI: 1689933616
Provider Name (Legal Business Name): BENJAMIN DEE SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5220 GREENS DAIRY RD
RALEIGH NC
27616-4612
US

IV. Provider business mailing address

5220 GREENS DAIRY RD
RALEIGH NC
27616-4612
US

V. Phone/Fax

Practice location:
  • Phone: 919-503-4456
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101280612
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number2017-01058
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: