Healthcare Provider Details

I. General information

NPI: 1154324358
Provider Name (Legal Business Name): MAURICE FREMONT-SMITH III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HAMPTON RD UNIT 208
EXETER NH
03833-4849
US

IV. Provider business mailing address

PO BOX 100519
ATLANTA GA
30384-0519
US

V. Phone/Fax

Practice location:
  • Phone: 888-208-6228
  • Fax: 603-778-1602
Mailing address:
  • Phone: 888-208-6228
  • Fax: 603-778-1602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number8796
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number74141
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: