Basic Information
| Provider Information | |||||||||
| NPI: | 1659716223 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | YALE DEPARTMENT OF ORTHOPEDICS AND REHABILITATION | ||||||||
| Address2: | PO BOX 208071 | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065208071 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 HOWARD AVE FL 1 | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037852579 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2013 | ||||||||
| LastUpdateDate: | 08/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 56521 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RS0010X | 56521 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine | 208000000X | 56521 | CT | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080S0010X | 56521 | CT | Y | Allopathic & Osteopathic Physicians | Pediatrics | Sports Medicine |
No ID Information.