Provider Demographics
NPI:1629112792
Name:PAUL N. SMITH, M.D., P.A.
Entity Type:Organization
Organization Name:PAUL N. SMITH, M.D., P.A.
Other - Org Name:BANGOR OB/GYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-945-6588
Mailing Address - Street 1:68 MOUNT HOPE AVE
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4096
Mailing Address - Country:US
Mailing Address - Phone:207-945-6588
Mailing Address - Fax:207-945-2955
Practice Address - Street 1:68 MOUNT HOPE AVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4096
Practice Address - Country:US
Practice Address - Phone:207-945-6588
Practice Address - Fax:207-945-2955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0004661923OtherAETNA
ME060976OtherANTHEM
ME228520000Medicaid
ME=========OtherTRICARE
ME0004661923OtherAETNA