Healthcare Provider Details

I. General information

NPI: 1730154022
Provider Name (Legal Business Name): BRIAN GERARD SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BRIAN SMITH MD

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

IV. Provider business mailing address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-9100
  • Fax: 860-837-6387
Mailing address:
  • Phone: 860-545-9100
  • Fax: 860-837-6387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number32300
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: