Individual
ROSHAN KUZHIVELI MATHEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
701 GROVE RD, GMH ER ADMINISTRATION, GREENVILLE, SC 29605-5611
(864) 455-6372
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
24200
SC
207Q00000X
Family Medicine Physician
24200
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0-618-090-5
ECFMG
SC
05
—
242008
—
SC
Enumeration date
07/12/2006
Last updated
06/11/2021
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