Provider Demographics
NPI:1235267816
Name:SMITH, PETER DAVIS (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:DAVIS
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAVIS
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:995 HOPMEADOW ST
Mailing Address - Street 2:WESTMINSTER SCHOOL HEALTH CENTER
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-1812
Mailing Address - Country:US
Mailing Address - Phone:860-408-3080
Mailing Address - Fax:860-408-3081
Practice Address - Street 1:995 HOPMEADOW ST
Practice Address - Street 2:WESTMINSTER SCHOOL HEALTH CENTER
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-1812
Practice Address - Country:US
Practice Address - Phone:860-408-3080
Practice Address - Fax:860-408-3081
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038927207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT110008154Medicare ID - Type Unspecified
CTH30859Medicare UPIN