Healthcare Provider Details

I. General information

NPI: 1689645566
Provider Name (Legal Business Name): CRAIG M SMITH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 01/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3073 WHITE MOUNTAIN HWY
NORTH CONWAY NH
03860
US

IV. Provider business mailing address

3073 WHITE MOUNTAIN HWY
NORTH CONWAY NH
03860-7101
US

V. Phone/Fax

Practice location:
  • Phone: 603-356-5472
  • Fax: 603-356-9647
Mailing address:
  • Phone: 603-356-5472
  • Fax: 603-356-9647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1888
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19095
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: