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General NPI Number Information
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NPI Number | 1962791467
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Entity Type | Individual
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Provider Name | MAXIMILIAN JAMES SMITH M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 06/26/2018
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Provider Practice Location Address
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Address Line | 41 MALL ROAD LAHEY HOSPITAL & MEDICAL CENTER
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City | BURLINGTON
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State | MA
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Zip | 01805-0001
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Country | US
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Telephone | 781-744-8170
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Fax | 781-744-5232
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Provider Business Mailing Address
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Address Line | 41 MALL ROAD LAHEY HOSPITAL & MEDICAL CENTER
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City | BURLINGTON
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State | MA
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Zip | 01805-0001
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Country | US
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Telephone | 781-744-8170
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Fax | 781-744-5232
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 57898
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 266093
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 2085D0003X
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Taxonomy Name | Diagnostic Neuroimaging (Radiology) Physician
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License Number | 266093
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 266093
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License Number State | MA
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