Provider Demographics
NPI:1710689534
Name:FIEGEL, MATTHEW
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:FIEGEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 MIDLAND PARKWAY
Mailing Address - Street 2:MEDICAL OFFICE BUILDING STE. 140
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8104
Mailing Address - Country:US
Mailing Address - Phone:843-998-1222
Mailing Address - Fax:
Practice Address - Street 1:295 MIDLAND PARKWAY
Practice Address - Street 2:MEDICAL OFFICE BUILDING STE. 140
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8104
Practice Address - Country:US
Practice Address - Phone:843-998-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program