1598777542 NPI number — MARILYN P SMITH MD

Table of content: MARILYN P SMITH MD (NPI 1598777542)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598777542 NPI number — MARILYN P SMITH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
MARILYN
Provider Middle Name:
P
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:
1598777542
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 CAMBRIDGE DR
Provider Second Line Business Mailing Address:
CREDENTIALS XPRESS
Provider Business Mailing Address City Name:
TRUMBULL
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06611-4764
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 MONROE TPKE
Provider Second Line Business Practice Location Address:
CANTERBURY PEDIATRICS
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06468-2276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-452-1063
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/11/2006

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:  030831 , 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: 001308312 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010030831CT04 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 36-4505937 . This is a "NEHCA HMC/PPO" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 36-4505937 . This is a "COMMUNITY HEALTH NETWORK" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2V2847 . This is a "HEALTH NET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 36-4505937 . This is a "MULTIPLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 507Y41 . This is a "EMPIRE BC/BS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 36-4505937 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 36-4505937 . This is a "FIRST HEALTH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 308310 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 36-4505937 . This is a "GREAT WEST HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 36-4505937 . This is a "NORTHEAST HEALTH DIRECT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 36-4505937 . This is a "PIONEER HEALTH NETWORK" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2999672 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 36-4505937 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 36-4505937 . This is a "POMCO" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 36-4505937 . This is a "CONSUMER HEALTH NETWORK" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 36-4505937 . This is a "NATIONAL PROVIDER NETWORK" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 4398415006 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: ZP164 . This is a "OXFORD HEALTH PLANS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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