Provider Demographics
NPI:1669784674
Name:GASKINS, MATTHEW ENGLISH (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ENGLISH
Last Name:GASKINS
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 1:14 MONCKTON BLVD STE 100A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206-4708
Mailing Address - Country:US
Mailing Address - Phone:803-764-3555
Mailing Address - Fax:803-765-4418
Practice Address - Street 1:4500 FORT JACKSON BLVD STE 270
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1119
Practice Address - Country:US
Practice Address - Phone:803-764-3555
Practice Address - Fax:803-764-4418
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD326362084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC326365Medicaid