1447325535 NPI number — MAURA ANGIELLO-SMITH MD

Table of content: MAURA ANGIELLO-SMITH MD (NPI 1447325535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447325535 NPI number — MAURA ANGIELLO-SMITH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANGIELLO-SMITH
Provider First Name:
MAURA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447325535
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1275 SUMMER ST
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
STAMFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06905-5359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-324-4100
Provider Business Mailing Address Fax Number:
203-969-1271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1275 SUMMER ST
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
STAMFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06905-5359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-324-4100
Provider Business Practice Location Address Fax Number:
203-969-1271
Provider Enumeration Date:
11/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  042324 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 042324 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 3538087 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P3254682 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 06-0873781 . This is a "GREAT WEST" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 11213145 . This is a "CAQH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 06-0873781 . This is a "NORTHEAST HEALTHCARE ALLI" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2V4896 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010042324CT01 . This is a "BLUE CROSS-STAMFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 06-0873781 . This is a "HUMANA CHOICECARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 06-0873781 . This is a "UNITED" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001423243 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010042324CT02 . This is a "BLUE CROSS-DARIEN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 06-0873781 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 06-0873781 . This is a "PHCS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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