Provider Demographics
NPI:1134173008
Name:SMITH, DANE EDWARD (MD)
Entity type:Individual
Prefix:
First Name:DANE
Middle Name:EDWARD
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 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:298 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-9443
Practice Address - Country:US
Practice Address - Phone:864-482-3230
Practice Address - Fax:864-482-3222
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12485208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4417333OtherAETNA ID
SCP00305815OtherRR MEDICARE
SC124859Medicaid
SC576007863142OtherBCBS OF SC ID
SC1407154OtherCIGNA ID
SC576007863132OtherBLUECHOICE HEALTHPLAN ID
SCP00305815OtherRR MEDICARE
SC4417333OtherAETNA ID
SC1407154OtherCIGNA ID