Provider Demographics
NPI:1437379450
Name:CHRISTINA M SMILLIE, MD
Entity Type:Organization
Organization Name:CHRISTINA M SMILLIE, MD
Other - Org Name:BREASTFEEDING RESOURCES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMILLIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-375-5812
Mailing Address - Street 1:2505 MAIN ST
Mailing Address - Street 2:SUITE 223
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-5839
Mailing Address - Country:US
Mailing Address - Phone:203-375-5812
Mailing Address - Fax:203-375-6027
Practice Address - Street 1:2505 MAIN ST
Practice Address - Street 2:SUITE 223
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-5839
Practice Address - Country:US
Practice Address - Phone:203-375-5812
Practice Address - Fax:203-375-6027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035447207Q00000X
CT022205208000000X
CT037361208000000X
CT050885208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001222059-00OtherANTHEM MEDICAID