Provider Demographics
NPI:1780113605
Name:SMITH, CAROLINE CAMPELO (MD)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:CAMPELO
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:CAMPELO
Other - Last Name:FERES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:96 JONATHAN LUCAS ST STE 708
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-8900
Mailing Address - Country:US
Mailing Address - Phone:843-792-8105
Mailing Address - Fax:843-792-3674
Practice Address - Street 1:171 ASHLEY AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-7208
Practice Address - Country:US
Practice Address - Phone:843-792-1414
Practice Address - Fax:843-792-3674
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10061202208100000X
SCMD93142208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation