Healthcare Provider Details

I. General information

NPI: 1740298033
Provider Name (Legal Business Name): ROY OOMEN MATHEW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6439 GARNERS FERRY RD MAIL CODE 111K
COLUMBIA SC
29209-1638
US

IV. Provider business mailing address

6439 GARNERS FERRY RD MAIL CODE 111K
COLUMBIA SC
29209-1638
US

V. Phone/Fax

Practice location:
  • Phone: 803-776-4000
  • Fax:
Mailing address:
  • Phone: 803-776-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA231100
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: