Healthcare Provider Details

I. General information

NPI: 1699903898
Provider Name (Legal Business Name): MATTHEW BERNSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 BLACK RIVER RD
GEORGETOWN SC
29440-3304
US

IV. Provider business mailing address

PO BOX 30309
CHARLESTON SC
29417-0309
US

V. Phone/Fax

Practice location:
  • Phone: 843-527-7171
  • Fax:
Mailing address:
  • Phone: 866-801-7177
  • Fax: 843-566-8780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberLL31869
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: