Provider Demographics
NPI:1881669448
Name:SMITH, WILLIAM R (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
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 1:7 THE LOPE
Mailing Address - Street 2:
Mailing Address - City:HAYDENVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01039
Mailing Address - Country:US
Mailing Address - Phone:413-320-2457
Mailing Address - Fax:413-268-7802
Practice Address - Street 1:7 THE LOPE
Practice Address - Street 2:
Practice Address - City:HAYDENVILLE
Practice Address - State:MA
Practice Address - Zip Code:01039
Practice Address - Country:US
Practice Address - Phone:413-320-2457
Practice Address - Fax:413-268-7802
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA42587207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA04-3194547OtherNORTH AMERICAN PREFERRED
MA04-3194547OtherNORTHEAST HEALTH DIRECT
MA04-3194547OtherPLAN VISTA
MA042587-G500OtherCONNECTICARE
MA04-3194547OtherCONSOLIDATED
MA04-3194547OtherUNICARE/GIC
MA36487OtherHEALTH NEW ENGLAND
MA04-3194547OtherPRIVATE HEALTHCARE SYSTEM
MA8432243OtherCIGNA
MA3013235Medicaid
MA04-3194547OtherGREAT-WEST
MA04-3194547OtherNORTHEAST HEALTHCARE ALLI
MA04-3194547OtherUNITED HEALTHCARE
MA32075OtherBMC
MA3982254OtherAETNA
MA470394OtherTUFTS
MAAA49485OtherHARVARD PILGRIM
MDJ05819OtherBCBSMA
MA3013235Medicaid
MA32075OtherBMC
C57512Medicare UPIN