Provider Demographics
NPI:1447258322
Name:SMITH, ELIZABETH COLBY (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:COLBY
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3 VICTORIA LN
Mailing Address - Street 2:
Mailing Address - City:WEST SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06092-2119
Mailing Address - Country:US
Mailing Address - Phone:860-324-2071
Mailing Address - Fax:
Practice Address - Street 1:1000 ASYLUM AVE
Practice Address - Street 2:SUITE 2109A
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1770
Practice Address - Country:US
Practice Address - Phone:860-714-6581
Practice Address - Fax:860-714-8311
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028128208000000X
CT28128208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001281287Medicaid
CTE37733Medicare UPIN
CT001281287Medicaid