Healthcare Provider Details

I. General information

NPI: 1982686929
Provider Name (Legal Business Name): BRIAN RICHARD SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 04/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST YNHH, CLINIC BUILDING 407
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

20 YORK ST YNHH, CLINIC BUILDING 407
NEW HAVEN CT
06510-3220
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-2286
  • Fax: 203-688-4111
Mailing address:
  • Phone: 203-688-2286
  • Fax: 203-688-4111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number029372
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number029372
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: