Healthcare Provider Details

I. General information

NPI: 1396926978
Provider Name (Legal Business Name): WAYNE C VIAL MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2007
Last Update Date: 11/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1867 SAVAGE RD
CHARLESTON SC
29407-4726
US

IV. Provider business mailing address

297 HOBCAW DR
MT PLEASANT SC
29464-2570
US

V. Phone/Fax

Practice location:
  • Phone: 843-763-5866
  • Fax: 843-763-8742
Mailing address:
  • Phone: 843-884-4507
  • Fax: 843-881-2269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number13429
License Number StateSC

VIII. Authorized Official

Name: DR. WAYNE C. VIAL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 843-884-4507