MEDICARE: DR. ROBERT S. SMITH DPM

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	213E00000X	Podiatrist	POO351	CT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	4800009600	OTHER	CT	RAILROAD MEDICARE ID#

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	061364754	OTHER	CT	PRIVATE INSURANCE /TAX ID
3	030000351CT03	OTHER	CT	BLUE CROSS PROVIDER #
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	0004271631	OTHER	CT	AETNA ID#
6	003935	OTHER	CT	HEALTHNET
7	6320755	OTHER	CT	CIGNA ID#

General Provider Information

NPI Number	:	1811981749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT S. SMITH DPM

Provider Business Mailing Address
First Line	:	3715 MAIN ST
Second Line	:	SUITE 306
City	:	BRIDGEPORT
State	:	CT
Zip	:	06606-3618
Country	:	US
Telephone Number	:	203-373-1775
Fax Number	:

Provider Business Practice Location Address
First Line	:	3715 MAIN ST
Second Line	:	SUITE 306
City	:	BRIDGEPORT
State	:	CT
Zip	:	06606-3618
Country	:	US
Telephone Number	:	203-373-1775
Fax Number	:

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	12/11/2007

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Directions to “ DR. ROBERT S. SMITH DPM” Practice Location

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