Provider Demographics
NPI:1295807022
Name:MATSIK, KRISTEN MARXEN (MD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARXEN
Last Name:MATSIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:ANN
Other - Last Name:MARXEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:295A MIDLAND PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-5902
Mailing Address - Country:US
Mailing Address - Phone:843-851-3800
Mailing Address - Fax:843-851-7787
Practice Address - Street 1:295A MIDLAND PKWY STE 220
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-5902
Practice Address - Country:US
Practice Address - Phone:843-851-3800
Practice Address - Fax:843-851-7787
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC85200207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A713950Medicare ID - Type Unspecified
H01010Medicare UPIN