Provider Demographics
NPI:1760531180
Name:SMITH, CHRISTINE BLAKE (DO)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:BLAKE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:D
Other - Last Name:BLAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:114 STROUDWATER ST
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-4037
Mailing Address - Country:US
Mailing Address - Phone:207-856-6792
Mailing Address - Fax:207-854-1146
Practice Address - Street 1:114 STROUDWATER ST
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4037
Practice Address - Country:US
Practice Address - Phone:207-856-6792
Practice Address - Fax:207-854-1146
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO2350204D00000X, 207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME409080099Medicaid
MEI11994Medicare UPIN