Provider Demographics
NPI:1922042654
Name:KORNEGAY, MATTHEW JUSTICE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JUSTICE
Last Name:KORNEGAY
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1483 TOBIAS GADSON BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4795
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1483 TOBIAS GADSON BLVD STE 101
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4795
Practice Address - Country:US
Practice Address - Phone:843-405-1110
Practice Address - Fax:855-654-2149
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC31144207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC311442Medicaid
SCP00834834OtherRAILROAD MEDICARE ID-RSFPN
SCAA32249223Medicare PIN