Healthcare Provider Details

I. General information

NPI: 1972980092
Provider Name (Legal Business Name): MATTHEW JOHN GESWELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 W MEETING ST STE 100
LANCASTER SC
29720-2245
US

IV. Provider business mailing address

PO BOX 602108
CHARLOTTE NC
28260-2108
US

V. Phone/Fax

Practice location:
  • Phone: 803-285-3700
  • Fax:
Mailing address:
  • Phone: 843-792-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number86693
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number86693
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: