Healthcare Provider Details

I. General information

NPI: 1952496424
Provider Name (Legal Business Name): SCOTT D SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CORPORATE DR STE 325
SHELTON CT
06484-6295
US

IV. Provider business mailing address

1 CORPORATE DR STE 325
SHELTON CT
06484-6295
US

V. Phone/Fax

Practice location:
  • Phone: 203-696-6125
  • Fax: 203-337-9731
Mailing address:
  • Phone: 203-696-6125
  • Fax: 203-337-9731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number05371
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number053871
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: