Provider Demographics
NPI:1831581446
Name:SMITH, SARA RANDOLPH (NP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:RANDOLPH
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MMP CAPE ELIZABETH INTERNAL MEDICINE
Mailing Address - Street 2:155 SPURWINK AVE
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107
Mailing Address - Country:US
Mailing Address - Phone:207-767-2174
Mailing Address - Fax:
Practice Address - Street 1:MMP CAPE ELIZABETH INTERNAL MEDICINE
Practice Address - Street 2:155 SPURWINK AVE
Practice Address - City:CAPE ELIZABETH
Practice Address - State:ME
Practice Address - Zip Code:04107
Practice Address - Country:US
Practice Address - Phone:207-767-2174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP211016363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health