Provider Demographics
NPI:1871625756
Name:SMAGINA, ELENA E (MD)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:E
Last Name:SMAGINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:008-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:15 WEST ST
Practice Address - Street 2:
Practice Address - City:EAST DOUGLAS
Practice Address - State:MA
Practice Address - Zip Code:01516-2160
Practice Address - Country:US
Practice Address - Phone:085-476-3291
Practice Address - Fax:508-547-6044
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA231164207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ41869OtherBCBS
MA110076112AMedicaid