Individual
MATTHEW MARCUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1210 W FARIS RD, GREENVILLE, SC 29605-4444
(864) 522-1800
(864) 522-1806
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(803) 296-3076
Taxonomy
Speciality
Code
Description
License number
State
2085P0229X
Pediatric Radiology Physician
Primary
30321
SC
2085R0202X
Diagnostic Radiology Physician
11731
RI
2085R0202X
Diagnostic Radiology Physician
30321
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007057522
—
RI
01
—
1988
NEIGHBORHOOD HEALTH PLAN
RI
01
—
1988
NHPRI
—
01
—
2101408
MASS MEDICAID
—
05
—
303219
—
SC
01
—
3961166
AETNA
—
01
—
412707
BLUE CHIP
—
01
—
7057523
RI MEDICAL ASSISTANCE
—
01
—
9385123
PHHCS
—
01
—
AA31230
RIH PILGRIM
—
Enumeration date
01/25/2006
Last updated
05/06/2021
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