Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | XS49444486 | MA |
Y | 208000000X | Pediatrician | 045662 | CT |
N | 208000000X | Pediatrician | MD7534 | RI |
NPI | 1215993993 |
---|---|
Provider Name | Richard D Smith |
First Address | Putnam, CT 06260-1836 |
Second Address | Putnam, CT 06260-1836 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2006 |
Last Update Date | 04/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7001347 | (05) | RI |
A72514 | (02) |