Healthcare Provider Details

I. General information

NPI: 1629060298
Provider Name (Legal Business Name): VICKI E SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 SOUTH ST
PITTSFIELD MA
01201-6804
US

IV. Provider business mailing address

408 SUMMIT RD
RICHMOND MA
01254-5151
US

V. Phone/Fax

Practice location:
  • Phone: 413-447-3888
  • Fax: 413-499-4455
Mailing address:
  • Phone: 413-698-2520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number55549
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: