Healthcare Provider Details

I. General information

NPI: 1063499226
Provider Name (Legal Business Name): NEWBERRY SURGICAL ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2541 EVANS STREET SUITE 100
NEWBERRY SC
29108
US

IV. Provider business mailing address

2541 EVANS STREET SUITE 100
NEWBERRY SC
29108
US

V. Phone/Fax

Practice location:
  • Phone: 803-276-7172
  • Fax: 803-276-7175
Mailing address:
  • Phone: 803-276-7172
  • Fax: 803-276-7175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN A MATZINGEH
Title or Position: PARTNER
Credential: MD
Phone: 803-276-7172