Provider Demographics
NPI:1962404889
Name:SMITH, BRENDA CATHERINE (MD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:CATHERINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 BLACKBURN RD
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1459
Mailing Address - Country:US
Mailing Address - Phone:412-749-7850
Mailing Address - Fax:412-749-7784
Practice Address - Street 1:720 BLACKBURN RD
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1459
Practice Address - Country:US
Practice Address - Phone:412-749-7850
Practice Address - Fax:412-749-7784
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038764F207RN0300X
PAMD038764E208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2225452Medicaid
WV1809938000Medicaid
PA0010895300002Medicaid
WV1809938000Medicaid
PA390006641Medicare PIN
OH2225452Medicaid
PA0010895300002Medicaid