Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | MD15639 | ME |
Y | 207VX0201X | Gynecologic Oncologist | MD15639 | ME |
NPI | 1205950003 |
---|---|
Provider Name | Laurie Small |
First Address | Scarborough, ME 04074-9701 |
Second Address | Scarborough, ME 04074-9692 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 26/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
261040099 | (05) | ME |
30202051 | (05) | NH |
H46304 | (02) |