1811906589 NPI number — LAWRENCE SMITH MD

Table of content: LAWRENCE SMITH MD (NPI 1811906589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811906589 NPI number — LAWRENCE SMITH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
LAWRENCE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811906589
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1599
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BANGOR
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04402-1599
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-945-5247
Provider Business Mailing Address Fax Number:
207-947-0435

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
735 WILSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BREWER
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04412-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-992-2601
Provider Business Practice Location Address Fax Number:
207-989-2280
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD12226 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1044064 . This is a "AETNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 010474554 . This is a "MEDNET" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: D78793 . This is a "HARVARD PLIGRIM HEALTHCAR" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: M61771 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 017716 . This is a "ANTHEM BC BS" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 319680099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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