Provider Demographics
NPI:1871539247
Name:SMILOWICZ, ALICIA (DO)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:SMILOWICZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-5718
Mailing Address - Country:US
Mailing Address - Phone:270-899-0307
Mailing Address - Fax:207-619-7295
Practice Address - Street 1:466 OCEAN AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-5718
Practice Address - Country:US
Practice Address - Phone:207-899-0307
Practice Address - Fax:207-619-7295
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1901204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30227644Medicaid
ME431974899Medicaid
MEP01029526Medicare PIN
MEME161703Medicare PIN
MEME161702Medicare PIN
MEME1617Medicare PIN
NH30227644Medicaid
MEME161701Medicare PIN