Individual
MS. DIANA SMITH
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1685 CONGRESS ST, PORTLAND, ME 04102
(207) 774-5816
(207) 774-3329
Mailing address
100 FODEN RD E, STE 201, SOUTH PORTLAND, ME 04106
(207) 828-0361
(207) 874-1483
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA495
ME
Other
Enumeration date
05/16/2006
Last updated
07/08/2007
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