Individual
DR. MATTHEW THOMAS CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 PATEWOOD DR STE A200, GREENVILLE, SC 29615-3580
(864) 454-5004
(864) 241-9202
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
55984
TN
2080P0216X
Pediatric Rheumatology Physician
Primary
87391
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
SC
Enumeration date
04/22/2014
Last updated
09/08/2022
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