Provider Demographics
NPI:1902821267
Name:SMITH, ALEXANDER BLAIR (M D)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:BLAIR
Last Name:SMITH
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 TOLLAND TPKE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-1609
Mailing Address - Country:US
Mailing Address - Phone:860-647-4796
Mailing Address - Fax:860-646-3945
Practice Address - Street 1:1075 TOLLAND TPKE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-1609
Practice Address - Country:US
Practice Address - Phone:860-647-4796
Practice Address - Fax:860-646-3945
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0351142083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC46422Medicare UPIN