Provider Demographics
NPI:1982688123
Name:SMITH, KATHLEEN J (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 SAINT JOHNSBURY RD
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:NH
Mailing Address - Zip Code:03561-3437
Mailing Address - Country:US
Mailing Address - Phone:603-444-7070
Mailing Address - Fax:603-444-4075
Practice Address - Street 1:580 SAINT JOHNSBURY RD
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561-3437
Practice Address - Country:US
Practice Address - Phone:603-444-7070
Practice Address - Fax:603-444-4075
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6828207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0000898Medicaid
NH70008987Medicaid
NH30518645Medicaid
NH80000898Medicaid
NHNH0783OtherMEDICARE B GROUP INFO
VT0303988Medicaid
NHNH0898Medicare PIN
NHNH0898Medicare ID - Type Unspecified
VT0000898Medicaid
NH303988Medicare Oscar/Certification