1235267816 NPI number — DR. PETER DAVIS SMITH MD

Table of content: DR. PETER DAVIS SMITH MD (NPI 1235267816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235267816 NPI number — DR. PETER DAVIS SMITH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
PETER
Provider Middle Name:
DAVIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
DAVIS
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1235267816
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
995 HOPMEADOW ST
Provider Second Line Business Mailing Address:
WESTMINSTER SCHOOL HEALTH CENTER
Provider Business Mailing Address City Name:
SIMSBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06070-1812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-408-3080
Provider Business Mailing Address Fax Number:
860-408-3081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
995 HOPMEADOW ST
Provider Second Line Business Practice Location Address:
WESTMINSTER SCHOOL HEALTH CENTER
Provider Business Practice Location Address City Name:
SIMSBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06070-1812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-408-3080
Provider Business Practice Location Address Fax Number:
860-408-3081
Provider Enumeration Date:
03/02/2007

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: 207R00000X , with the licence number:  038927 , 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)