Provider Demographics
NPI:1447325535
Name:ANGIELLO-SMITH, MAURA (MD)
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:
Last Name:ANGIELLO-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 1:1275 SUMMER ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5359
Mailing Address - Country:US
Mailing Address - Phone:203-324-4100
Mailing Address - Fax:203-969-1271
Practice Address - Street 1:1275 SUMMER ST
Practice Address - Street 2:SUITE 301
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5359
Practice Address - Country:US
Practice Address - Phone:203-324-4100
Practice Address - Fax:203-969-1271
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042324208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT042324OtherCONNECTICARE
CT3538087OtherAETNA
CTP3254682OtherOXFORD
CT06-0873781OtherGREAT WEST
CT11213145OtherCAQH
CT06-0873781OtherNORTHEAST HEALTHCARE ALLI
CT2V4896OtherHEALTHNET
CT010042324CT01OtherBLUE CROSS-STAMFORD
CT06-0873781OtherHUMANA CHOICECARE
CT06-0873781OtherUNITED
CT001423243Medicaid
CT010042324CT02OtherBLUE CROSS-DARIEN
CT06-0873781OtherCIGNA
CT06-0873781OtherPHCS
CT2V4896OtherHEALTHNET