Healthcare Provider Details

I. General information

NPI: 1790778645
Provider Name (Legal Business Name): VINCENT M SOMAIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 SEAGRASS STATION RD
BLUFFTON SC
29910-9549
US

IV. Provider business mailing address

107 SEAGRASS STATION RD
BLUFFTON SC
29910-9549
US

V. Phone/Fax

Practice location:
  • Phone: 843-836-8200
  • Fax: 843-836-8595
Mailing address:
  • Phone: 843-422-4413
  • Fax: 866-848-1697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number82033
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: