Provider Demographics
NPI:1356330260
Name:BRANDLI, DAVID WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WILLIAM
Last Name:BRANDLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2687 LAKE PARK DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406
Mailing Address - Country:UM
Mailing Address - Phone:843-572-1010
Mailing Address - Fax:
Practice Address - Street 1:295 A MIDLAND PARKWAY
Practice Address - Street 2:STE 100
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-9171
Practice Address - Country:US
Practice Address - Phone:843-871-5220
Practice Address - Fax:843-871-5547
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23790208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4871Medicaid
SCP00036601OtherRR MEDICARE
H80322Medicare UPIN
SCP00036601OtherRR MEDICARE