Individual
ED R SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
44 S MAIN ST, RADIOLOGY DEPT, RANDOLPH, VT 05060-1381
(802) 728-2214
(802) 728-2613
Mailing address
44 S MAIN ST, RADIOLOGY DEPT, RANDOLPH, VT 05060-1381
(802) 728-2214
(802) 728-2613
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
0420007374
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1389391
—
LA
Enumeration date
09/18/2007
Last updated
09/18/2007
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