Provider Demographics
NPI:1487067476
Name:MATTHIAS, KATHERINE MARIE (DO)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARIE
Last Name:MATTHIAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:800 N A ST
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-2144
Practice Address - Country:US
Practice Address - Phone:864-855-0001
Practice Address - Fax:864-855-5030
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36690208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC366990Medicaid
SCSCB281OtherMEDICARE