Healthcare Provider Details

I. General information

NPI: 1912453150
Provider Name (Legal Business Name): MAHER MATAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MUSC DEPARTMENT OF SURGERY-TRAUMA 96 JONATHAN LUCAS ST STE 420 CSB MSC 613
CHARLESTON SC
29425
US

IV. Provider business mailing address

300 SEAPORT LN APT. 1309
MOUNT PLEASANT SC
29464-2997
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-3373
  • Fax:
Mailing address:
  • Phone: 843-557-7910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberLL40065
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: