Healthcare Provider Details

I. General information

NPI: 1225732175
Provider Name (Legal Business Name): MATTHEW ROBERT HARBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 19TH ST S
BIRMINGHAM AL
35233-1900
US

IV. Provider business mailing address

169 ASHLEY AVE ROOM 202 MAIN HOSPITAL, MSC333
CHARLESTON SC
29425
US

V. Phone/Fax

Practice location:
  • Phone: 205-638-9589
  • Fax:
Mailing address:
  • Phone: 843-792-9570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number96697
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number96697
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: