Healthcare Provider Details

I. General information

NPI: 1437379450
Provider Name (Legal Business Name): CHRISTINA M SMILLIE, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 04/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 MAIN ST SUITE 223
STRATFORD CT
06615-5839
US

IV. Provider business mailing address

2505 MAIN ST SUITE 223
STRATFORD CT
06615-5839
US

V. Phone/Fax

Practice location:
  • Phone: 203-375-5812
  • Fax: 203-375-6027
Mailing address:
  • Phone: 203-375-5812
  • Fax: 203-375-6027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number035447
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number022205
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number037361
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number050885
License Number StateCT

VIII. Authorized Official

Name: CHRISTINA M SMILLIE
Title or Position: MD
Credential: MD
Phone: 203-375-5812