Healthcare Provider Details

I. General information

NPI: 1255386421
Provider Name (Legal Business Name): STEVEN SCOTT SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 FARMINGTON AVE SUITE 210
FARMINGTON CT
06032-1936
US

IV. Provider business mailing address

399 FARMINGTON AVE SUITE 210
FARMINGTON CT
06032-1936
US

V. Phone/Fax

Practice location:
  • Phone: 860-548-7338
  • Fax: 860-524-2654
Mailing address:
  • Phone: 860-548-7338
  • Fax: 860-524-2654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number044322
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number044322
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number044322
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number044322
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: