Individual
ROBERT P SMITH JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
50 FODEN RD, STE 3, SOUTH PORTLAND, ME 04106-1718
(207) 774-5816
(207) 523-8594
Mailing address
100 GANNETT DRIVE, SUITE C, SOUTH PORTLAND, ME 04106
(207) 523-3649
(207) 874-1483
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD12397
ME
207RI0200X
Infectious Disease Physician
Primary
MD12397
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010550
ANTHEM
—
01
—
1040616
AETNA
—
05
—
238250099
—
ME
Enumeration date
03/18/2006
Last updated
01/31/2019
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