Provider Demographics
NPI:1518062850
Name:SMITH, EVELYN (MD)
Entity Type:Individual
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First Name:EVELYN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2110 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2313
Mailing Address - Country:US
Mailing Address - Phone:860-258-3480
Mailing Address - Fax:860-571-6800
Practice Address - Street 1:704 HEBRON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-5020
Practice Address - Country:US
Practice Address - Phone:860-659-1379
Practice Address - Fax:860-659-4648
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2015-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT021995207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC59707Medicare UPIN