Healthcare Provider Details

I. General information

NPI: 1821047192
Provider Name (Legal Business Name): LINDA MARIE SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 SOUTH ST STE 3
BOW NH
03304-3419
US

IV. Provider business mailing address

514 SOUTH ST STE 3
BOW NH
03304-3419
US

V. Phone/Fax

Practice location:
  • Phone: 603-333-2384
  • Fax:
Mailing address:
  • Phone: 603-333-2384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number81023
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD171858
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21251
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: