Provider Demographics
NPI:1689770950
Name:SMITH, RICHARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
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 1:455 LEWIS AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451
Mailing Address - Country:US
Mailing Address - Phone:203-639-7272
Mailing Address - Fax:203-639-7224
Practice Address - Street 1:455 LEWIS AVE
Practice Address - Street 2:STE 205
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451
Practice Address - Country:US
Practice Address - Phone:203-639-7272
Practice Address - Fax:203-639-7224
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT18618207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0R1876OtherHEALTHNET
CT732550OtherCONNECTICARE
B38081Medicare UPIN