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General NPI Number Information
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NPI Number | 1437379450
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Entity Type | Organization
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Legal Business Name | CHRISTINA M SMILLIE, MD
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 04/23/2014
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Provider Practice Location Address
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Address Line | 2505 MAIN ST SUITE 223
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City | STRATFORD
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State | CT
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Zip | 06615-5839
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Country | US
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Telephone | 203-375-5812
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Fax | 203-375-6027
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Provider Business Mailing Address
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Address Line | 2505 MAIN ST SUITE 223
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City | STRATFORD
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State | CT
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Zip | 06615-5839
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Country | US
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Telephone | 203-375-5812
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Fax | 203-375-6027
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Authorized Official
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Title or Position | MD
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Name | CHRISTINA M SMILLIE
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Credential | MD
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Telephone | 203-375-5812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 050885
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 035447
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 037361
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 022205
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License Number State | CT
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