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General NPI Number Information
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NPI Number | 1205950003
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Entity Type | Individual
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Provider Name | LAURIE SMALL MD
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Gender | Female
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 11/26/2014
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Provider Practice Location Address
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Address Line | 102 CAMPUS DR
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City | SCARBOROUGH
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State | ME
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Zip | 04074-9692
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Country | US
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Telephone | 207-883-0069
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Fax | 207-883-0999
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Provider Business Mailing Address
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Address Line | 301C US ROUTE 1
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City | SCARBOROUGH
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State | ME
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Zip | 04074-9701
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Country | US
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Telephone | 207-396-8600
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Fax | 207-396-8632
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | MD15639
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD15639
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License Number State | ME
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