Healthcare Provider Details

I. General information

NPI: 1588016661
Provider Name (Legal Business Name): MATTHEW JOSEPH GARDNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 INDEPENDENCE PT STE 300
GREENVILLE SC
29615-4569
US

IV. Provider business mailing address

41 SOUTHEAST 5TH STREET UNIT 1401
MIAMI FL
33131
US

V. Phone/Fax

Practice location:
  • Phone: 864-522-3700
  • Fax: 864-522-3705
Mailing address:
  • Phone: 412-523-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA358
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number114
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: