Provider Demographics
NPI:1881634350
Name:SMITH, JENIE M (MD)
Entity Type:Individual
Prefix:DR
First Name:JENIE
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-5801
Mailing Address - Country:US
Mailing Address - Phone:207-783-1449
Mailing Address - Fax:207-777-3865
Practice Address - Street 1:710 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5801
Practice Address - Country:US
Practice Address - Phone:207-783-1449
Practice Address - Fax:207-777-3865
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME015392207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEM54225COtherCIGNA
MECC/010349848,003OtherANTHEM BC/BS
MESM MM8369Medicare ID - Type UnspecifiedINDIVIDUAL #
ME152622Medicare ID - Type UnspecifiedGROUP MEDICARE #
MEM54225COtherCIGNA