Provider Demographics
NPI:1952496424
Name:SMITH, SCOTT D (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:D
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 CORPORATE DR STE 325
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-6295
Mailing Address - Country:US
Mailing Address - Phone:203-696-6125
Mailing Address - Fax:203-337-9731
Practice Address - Street 1:1 CORPORATE DR STE 325
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6295
Practice Address - Country:US
Practice Address - Phone:203-696-6125
Practice Address - Fax:203-337-9731
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT053712085N0700X
CT0538712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT002092701Medicare PIN