Provider Demographics
NPI:1306831771
Name:SMITH, VIVIENNE E (MD)
Entity type:Individual
Prefix:
First Name:VIVIENNE
Middle Name:E
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 1:7 SOUTHWOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12211-2526
Mailing Address - Country:US
Mailing Address - Phone:518-292-6000
Mailing Address - Fax:518-292-6050
Practice Address - Street 1:7 SOUTHWOODS BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12211-2526
Practice Address - Country:US
Practice Address - Phone:518-292-6000
Practice Address - Fax:518-292-6050
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135921207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01235758Medicaid
NY060067432OtherRR MEDICARE
MA2086841Medicaid
NY060067432OtherRR MEDICARE
NYCC8781Medicare PIN