Provider Demographics
NPI:1164757670
Name:SMITH, BRIAN SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:SCOTT
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:55 MOHAWK ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047-2600
Mailing Address - Country:US
Mailing Address - Phone:518-233-3100
Mailing Address - Fax:518-233-3131
Practice Address - Street 1:55 MOHAWK ST
Practice Address - Street 2:SUITE 201
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047-2600
Practice Address - Country:US
Practice Address - Phone:518-233-3100
Practice Address - Fax:518-233-3131
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY182363-1207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine