Healthcare Provider Details

I. General information

NPI: 1831124809
Provider Name (Legal Business Name): GJANJE L SMITH-MATHUS M.D., MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 06/30/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NEW BERN AVE
RALEIGH NC
27610-1295
US

IV. Provider business mailing address

3000 NEW BERN AVE
RALEIGH NC
27610-1231
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-1570
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number230008
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD60140054
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License NumberMD60140054
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number2021-03043
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number2021-03043
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: