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NPI Code Detail

MEDICARE: CHRISTINA MARIE SMITH

MEDICARE: CHRISTINA MARIE SMITH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1518021187
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINA MARIE SMITH
Provider Business Mailing Address
First Line : 274 NEPONSET VALLEY PKWY
Second Line :
City : HYDE PARK
State : MA
Zip : 02136-2533
Country : US
Telephone Number : 617-442-8800
Fax Number :
Provider Business Practice Location Address
First Line : 1800 COLUMBUS AVE
Second Line :
City : ROXBURY
State : MA
Zip : 02119-1042
Country : US
Telephone Number : 617-442-8800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2006
Last Update Date : 07/08/2007

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