Healthcare Provider Details

I. General information

NPI: 1396107009
Provider Name (Legal Business Name): MATTHEW EARL MALUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 CHARLOTTE HWY
INDIAN LAND SC
29707-7591
US

IV. Provider business mailing address

801 E MOREHEAD ST STE 100
CHARLOTTE NC
28202-3195
US

V. Phone/Fax

Practice location:
  • Phone: 939-275-8305
  • Fax:
Mailing address:
  • Phone: 704-926-5547
  • Fax: 980-533-7801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2022-01408
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number2022-01408
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: