Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | MD15774 | ME |
N | 208000000X | Pediatrician | MD15774 | ME |
NPI | 1104976638 |
---|---|
Provider Name | Rosemarie Smith |
First Address | Scarborough, ME 04074-9701 |
Second Address | Portland, ME 04102-2169 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 02/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
278070099 | (05) | ME |
30201683 | (05) | NH |
G97489 | (02) | ME |