Provider Demographics
NPI:1881642999
Name:SMITH, RONALD DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:DAVID
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 1:574 WILLIS ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-7267
Mailing Address - Country:US
Mailing Address - Phone:959-217-1500
Mailing Address - Fax:959-217-1500
Practice Address - Street 1:574 WILLIS ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-7267
Practice Address - Country:US
Practice Address - Phone:959-217-1500
Practice Address - Fax:959-217-1500
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2020002080P0204X, 2080P0203X
SD56892080P0203X
NV117782080P0203X
NC2001004662080P0203X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100447610AMedicaid
TX158971501Medicaid
SCQ0046DMedicaid
MS05058544Medicaid
NJ8891206Medicaid
VI006738460Medicaid
MD401844300Medicaid
AZ702276Medicaid
GA000958361XMedicaid
LA1140937Medicaid
NY02258588Medicaid
OH2115124Medicaid
AL009973360Medicaid
NV100509717Medicaid
IN200479090Medicaid
KY64041510Medicaid
OK200005950AMedicaid
NC89128HVMedicaid
SCQ0046DMedicaid
NJ8891206Medicaid