Healthcare Provider Details

I. General information

NPI: 1588744957
Provider Name (Legal Business Name): BRENDAN E SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 OKATIE CENTER BOULEVARD SOUTH SUITE 101
OKATIE SC
29909-7533
US

IV. Provider business mailing address

16 OKATIE CENTER BLVD S STE 101
OKATIE SC
29909-7535
US

V. Phone/Fax

Practice location:
  • Phone: 843-705-8940
  • Fax: 843-705-6816
Mailing address:
  • Phone: 843-705-8940
  • Fax: 843-705-6816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number22095
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: