Individual
DR. STEPHEN ROBERT SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 SHAWS CV, NEW LONDON, CT 06320-4902
(860) 447-8304
(860) 443-8720
Mailing address
575 MAIN ST FL 2, ATTN: CREDENTIALING DPT, MIDDLETOWN, CT 06457-2845
(860) 347-6971
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
017278
CT
207Q00000X
Family Medicine Physician
5609
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004236346
—
CT
Enumeration date
03/23/2007
Last updated
04/24/2012
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