Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | MD23136 | ME |
NPI | 1295199453 |
---|---|
Provider Name | Carlen Smith |
First Address | Augusta, ME 04330-5758 |
Second Address | Augusta, ME 04330-5758 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2016 |
Last Update Date | 06/09/2019 |