Healthcare Provider Details

I. General information

NPI: 1023206968
Provider Name (Legal Business Name): IRVING S SMITH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 ST JOHNSBURY ROAD
LITTLETON NH
03561
US

IV. Provider business mailing address

600 ST JOHNSBURY ROAD
LITTLETON NH
03561
US

V. Phone/Fax

Practice location:
  • Phone: 860-364-7029
  • Fax: 860-364-7079
Mailing address:
  • Phone: 860-364-7029
  • Fax: 860-364-7079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number048601
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number048601
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: