Individual
MATTHEW W. BOGART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
96 JONATHAN LUCAS STREET CSB 822, MSC 624, CHARLESTON, SC 29425-5294
(843) 985-0999
(843) 985-9696
Mailing address
PO BOX 530062, ATLANTA, GA 30353-0062
(843) 695-6071
(843) 569-5879
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
21740
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP5764
—
SC
Enumeration date
01/29/2019
Last updated
08/18/2022
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