Individual
MR. MATTHEW MORGAN MOAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-2106
(843) 792-0269
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
39233
SC
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
39233
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39233
SC LLR
SC
Enumeration date
05/02/2013
Last updated
12/14/2020
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