Matthew Walter Jaenicke, M.D.
Internal Medicine, Rheumatology in Mt Pleasant, SC. Individual provider (NPI-1).
NPI number1063892008
StatusActive
Last updated in NPPESApr 24, 2025
Details
- NPI
- 1063892008
- Entity type
- Individual (NPI-1)
- Name
- Matthew Walter Jaenicke
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jun 4, 2015
- Certification date
- Nov 12, 2020
- Last updated
- Apr 24, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207RR0500X | Internal Medicine, Rheumatology | 38299 | SC | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | VT |
Practice location
890 Johnnie Dodds Blvd Suite 2aMt Pleasant, SC 29464
Phone 843-881-9971 · Fax 843-881-9973
Mailing address
890 Johnnie Dodds Blvd Suite 2aMt Pleasant, SC 29464
Phone 843-881-9971 · Fax 843-881-9973
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