Provider Demographics
NPI:1528465820
Name:SMYTH, BRENDAN JAMES (PHD/ MD)
Entity type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:JAMES
Last Name:SMYTH
Suffix:
Gender:M
Credentials:PHD/ MD
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Mailing Address - Street 1:4025 FLORA PL
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-3603
Mailing Address - Country:US
Mailing Address - Phone:610-209-8740
Mailing Address - Fax:
Practice Address - Street 1:311 PENNINGTON ROCKY HILL RD
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-2130
Practice Address - Country:US
Practice Address - Phone:609-818-4824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.114418207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036.114418OtherIL STATE MEDICAL LICENSE