MEDICARE: PETER C DEVITO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	6164	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871513150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER C DEVITO M.D.

Provider Business Mailing Address
First Line	:	1050 SAINT ANDREWS BLVD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-7173
Country	:	US
Telephone Number	:	843-571-2350
Fax Number	:	843-571-2351

Provider Business Practice Location Address
First Line	:	1050 SAINT ANDREWS BLVD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-7173
Country	:	US
Telephone Number	:	843-571-2350
Fax Number	:	843-571-2351

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	07/08/2007

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