Healthcare Provider Details

I. General information

NPI: 1760471460
Provider Name (Legal Business Name): SCOTT D SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 02/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 CATAMOUNT PARK
MIDDLEBURY VT
05753-1292
US

IV. Provider business mailing address

104 PORTER DR
MIDDLEBURY VT
05753-8527
US

V. Phone/Fax

Practice location:
  • Phone: 802-388-7185
  • Fax: 802-388-3445
Mailing address:
  • Phone: 802-388-8808
  • Fax: 802-388-8322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0420009805
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: