Provider Demographics
NPI:1497724561
Name:SMITH, KRISTIN CAROL (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:CAROL
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 CAMPUS DR UNIT 121
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7172
Mailing Address - Country:US
Mailing Address - Phone:207-396-7788
Mailing Address - Fax:207-396-8500
Practice Address - Street 1:100 CAMPUS DR UNIT 121
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7172
Practice Address - Country:US
Practice Address - Phone:207-396-7788
Practice Address - Fax:207-396-8500
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205584208600000X
MEMD29567208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0102032Medicaid
MAJ22911OtherBCBS
MA0102032Medicaid
MAA31127Medicare ID - Type Unspecified