Provider Demographics
NPI:1245541721
Name:SMITH, RYAN MATHEW (DO)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:MATHEW
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BOYNTON ST
Mailing Address - Street 2:
Mailing Address - City:EASTPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04631-1306
Mailing Address - Country:US
Mailing Address - Phone:207-853-6001
Mailing Address - Fax:
Practice Address - Street 1:30 BOYNTON ST
Practice Address - Street 2:
Practice Address - City:EASTPORT
Practice Address - State:ME
Practice Address - Zip Code:04631-1306
Practice Address - Country:US
Practice Address - Phone:207-853-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT032.00799452084P0800X
ME22612084P0800X
NH157732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry