Provider Demographics
NPI:1043241615
Name:SMITH, JEAN F (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:F
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:909 N MAIN ST
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5752
Mailing Address - Country:US
Mailing Address - Phone:401-521-2002
Mailing Address - Fax:401-521-6862
Practice Address - Street 1:909 N MAIN ST
Practice Address - Street 2:SUITE B-1
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5752
Practice Address - Country:US
Practice Address - Phone:401-521-2002
Practice Address - Fax:401-521-6862
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RI9167207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0406842OtherUH
200570126OtherTRICARE
406229OtherTUFTS
290865OtherBC
400494OtherBLUE CHIP
RI9004024Medicaid
898538800OtherCIGNA
3009811OtherAETNA
200570126OtherNEIGHBORHOOD HEALTH
A53896OtherHARVARD PILGRIM
3009811OtherAETNA
A53896OtherHARVARD PILGRIM