Healthcare Provider Details

I. General information

NPI: 1912062118
Provider Name (Legal Business Name): DEBORAH A SMITH P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 WINDHAM RD
PELHAM NH
03076-2372
US

IV. Provider business mailing address

33 WINDHAM RD
PELHAM NH
03076-2372
US

V. Phone/Fax

Practice location:
  • Phone: 603-577-2273
  • Fax: 603-577-5191
Mailing address:
  • Phone: 603-577-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number262
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: