Healthcare Provider Details

I. General information

NPI: 1396932612
Provider Name (Legal Business Name): ELIZABETH M. SMOLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH MORTARELLI SMOLA M.D,

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 08/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 DUNHAMTOWN BRIMFIELD ROAD
BRIMFIELD MA
01010
US

IV. Provider business mailing address

1529 DUNHAMTOWN BRIMFIELD ROAD
BRIMFIELD MA
01010
US

V. Phone/Fax

Practice location:
  • Phone: 413-245-6234
  • Fax:
Mailing address:
  • Phone: 413-245-6234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number42942
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number42942
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: