Provider Demographics
NPI:1265457253
Name:SMITH, STEVEN BRADBURY (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:BRADBURY
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 VT ROUTE 12
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VT
Mailing Address - Zip Code:05091-8172
Mailing Address - Country:US
Mailing Address - Phone:802-457-4809
Mailing Address - Fax:
Practice Address - Street 1:32 PLEASANT STREET
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VT
Practice Address - Zip Code:05091
Practice Address - Country:US
Practice Address - Phone:802-457-3030
Practice Address - Fax:802-457-2157
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0007558207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0009064Medicaid
VTSMVT9064Medicare ID - Type Unspecified
VTD66106Medicare UPIN