1114011996 NPI number — PAMELA SMITH-NOEL

Table of content: PAMELA SMITH-NOEL (NPI 1114011996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114011996 NPI number — PAMELA SMITH-NOEL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH-NOEL
Provider First Name:
PAMELA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1114011996
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
328 MAIN ST
Provider Second Line Business Mailing Address:
STUDIO 203
Provider Business Mailing Address City Name:
ROCKLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04841-3365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-594-9095
Provider Business Mailing Address Fax Number:
207-594-9095

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
328 MAIN ST
Provider Second Line Business Practice Location Address:
STUDIO 203
Provider Business Practice Location Address City Name:
ROCKLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04841-3365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-594-9095
Provider Business Practice Location Address Fax Number:
207-594-9095
Provider Enumeration Date:
10/03/2006

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: 1041C0700X , with the licence number:  LC6887 , 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: 424270099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104000000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com