Provider Demographics
NPI:1629015862
Name:ROEHRS, MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:ROEHRS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100174
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-3174
Mailing Address - Country:US
Mailing Address - Phone:864-512-5800
Mailing Address - Fax:864-512-5292
Practice Address - Street 1:16 ROBERTS BLVD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:SC
Practice Address - Zip Code:29697-1136
Practice Address - Country:US
Practice Address - Phone:648-512-5800
Practice Address - Fax:864-512-5292
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22649207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00034736OtherMEDCOST
SC226491Medicaid
181818395AOtherRAILROAD MEDICARE
SCH86842Medicare UPIN
P00034736OtherMEDCOST