Provider Demographics
NPI:1609834068
Name:SMITH, DAVID KEVIN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:KEVIN
Last Name:SMITH
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 1:725 LONG POINT RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8226
Mailing Address - Country:US
Mailing Address - Phone:843-971-8180
Mailing Address - Fax:843-971-9239
Practice Address - Street 1:1300 HOSPITAL DR
Practice Address - Street 2:STE 250
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464
Practice Address - Country:US
Practice Address - Phone:843-971-8180
Practice Address - Fax:843-971-9239
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8893207VG0400X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3545Medicaid
SCD18283Medicare UPIN
SCGP3545Medicaid