Provider Demographics
NPI:1376595595
Name:ZITELLO, PHILIP JAMES (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:JAMES
Last Name:ZITELLO
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 1:222 PEMBROKE DR
Mailing Address - Street 2:BUILDING C
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-6201
Mailing Address - Country:US
Mailing Address - Phone:843-682-2345
Mailing Address - Fax:843-682-2343
Practice Address - Street 1:222 PEMBROKE DR
Practice Address - Street 2:BUILDING C
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-6201
Practice Address - Country:US
Practice Address - Phone:843-682-2345
Practice Address - Fax:843-682-2343
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19791207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC197913Medicaid
SC197913Medicaid