Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 037656 | CT |
NPI | 1205834199 |
---|---|
Provider Name | Dr. Lori Storch Smith |
First Address | Westport, CT 06880-4315 |
Second Address | Westport, CT 06880-4315 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 08/07/2007 |