Healthcare Provider Details

I. General information

NPI: 1801067947
Provider Name (Legal Business Name): DR. ANDREW T. SMITH, DPM, DBA AUGUSTA FOOT AND ANKLE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 EASTERN AVE
AUGUSTA ME
04330-5722
US

IV. Provider business mailing address

26 EASTERN AVE
AUGUSTA ME
04330-5722
US

V. Phone/Fax

Practice location:
  • Phone: 207-623-5100
  • Fax: 208-621-1822
Mailing address:
  • Phone: 207-623-5100
  • Fax: 208-621-1822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD1036
License Number StateME

VIII. Authorized Official

Name: DR. ANDREW T SMITH
Title or Position: PODIATRIST
Credential: DPM
Phone: 207-623-5100