Individual
MATTHEW BONAVITA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
169 ASHLEY AVE RM 202, CHARLESTON, SC 29425-8905
(843) 876-7080
Mailing address
169 ASHLEY AVE, CHARLESTON, SC 29425-8905
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
LL90327
SC
208D00000X
General Practice Physician
90327
SC
Other
Enumeration date
06/22/2023
Last updated
05/27/2025
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