Individual
MATTHEW P GANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9263 MEDICAL PLAZA DR, STE E, CHARLESTON, SC 29406-7112
(843) 572-1228
(877) 561-7564
Mailing address
9263 MEDICAL PLAZA DR, STE E, CHARLESTON, SC 29406-7112
(843) 572-1228
(877) 561-7564
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
33892
SC
207R00000X
Internal Medicine Physician
240694-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
338921
—
SC
Enumeration date
12/28/2006
Last updated
06/06/2012
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