Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 13079 | NH |
N | 207YP0228X | Pediatric Otolaryngology | 13079 | NH |
NPI | 1386668135 |
---|---|
Provider Name | Dr. Mark Christopher Smith |
First Address | Lebanon, NH 03756-1000 |
Second Address | Lebanon, NH 03756-1000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 08/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1012791 | (05) | VT |
30206148 | (05) | NH |
I56058 | (02) |