Provider Demographics
NPI:1841238680
Name:SMITH, JESSICA LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LEIGH
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 9484
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02940-9484
Mailing Address - Country:US
Mailing Address - Phone:401-854-2500
Mailing Address - Fax:401-854-2519
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:CLAVERICK 2
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-519-1604
Practice Address - Fax:401-272-0538
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD12070207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA12/29/2008OtherTUFTS HEALTH PLAN
RIP00430740OtherRI MEDICARE
RI06/11/2009OtherNHPRI
RI04/15/2009OtherUNITED HEALTH CARE
MA2117991Medicaid
RI7058565Medicaid
RI1841238680OtherNPI
RI939025129OtherRI MEDICARE GROUP NUMBER
RI06/11/2009OtherNHPRI
RII54187Medicare UPIN