Individual
MATTHEW CHASE LUSTIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9 RICHLAND MEDICAL PARK DR STE 110, COLUMBIA, SC 29203-6859
(803) 434-7951
(803) 758-0134
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
Taxonomy
Speciality
Code
Description
License number
State
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
Primary
87712
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/06/2017
Last updated
06/07/2022
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