Provider Demographics
NPI:1114076965
Name:SMITH, CYNTHIA SUSANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:SUSANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:CENTRAL VERMONT MEDICAL CENTER - FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-479-2546
Mailing Address - Fax:802-479-1346
Practice Address - Street 1:14 N MAIN ST STE 4002
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-4505
Practice Address - Country:US
Practice Address - Phone:802-479-2546
Practice Address - Fax:802-479-1346
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.0010632207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009914Medicaid
VTH91449Medicare UPIN
VT1009914Medicaid
VTH91449Medicare UPIN