Healthcare Provider Details

I. General information

NPI: 1831581446
Provider Name (Legal Business Name): SARA RANDOLPH SMITH N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 12/19/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MMP CAPE ELIZABETH INTERNAL MEDICINE 155 SPURWINK AVE
CAPE ELIZABETH ME
04107
US

IV. Provider business mailing address

MMP CAPE ELIZABETH INTERNAL MEDICINE 155 SPURWINK AVE
CAPE ELIZABETH ME
04107
US

V. Phone/Fax

Practice location:
  • Phone: 207-767-2174
  • Fax:
Mailing address:
  • Phone: 207-767-2174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCNP211016
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: