Healthcare Provider Details

I. General information

NPI: 1801099023
Provider Name (Legal Business Name): VICKI SMITH MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 03/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 SOUTH ST
PITTSFIELD MA
01201-6804
US

IV. Provider business mailing address

374 SOUTH ST
PITTSFIELD MA
01201-6804
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. VICKI SMITH
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 413-447-3888