MEDICARE: SANFORD SMOOT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	0101277661	VA
2	2085R0202X	Diagnostic Radiology Physician	51966	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720072697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANFORD SMOOT MD

Provider Business Mailing Address
First Line	:	18 HOLMES RD
Second Line	:
City	:	LEXINGTON
State	:	MA
Zip	:	02420-1917
Country	:	US
Telephone Number	:	781-862-1429
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 HOLMES RD
Second Line	:
City	:	LEXINGTON
State	:	MA
Zip	:	02420-1917
Country	:	US
Telephone Number	:	781-862-1429
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	09/16/2025

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Directions to “ SANFORD SMOOT MD” Practice Location

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