Provider Demographics
NPI:1154415149
Name:SMITH, MATTHEW L (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:L
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:PO BOX 26383
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-1383
Mailing Address - Country:US
Mailing Address - Phone:864-234-1433
Mailing Address - Fax:
Practice Address - Street 1:105 HALTON VILLAGE CIR STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6832
Practice Address - Country:US
Practice Address - Phone:864-234-1433
Practice Address - Fax:864-286-1462
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD15071207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCF58754Medicare UPIN
SC8157Medicare ID - Type UnspecifiedMEDICARE