Provider Demographics
NPI:1689656498
Name:SPECIALE, VITO (DPM)
Entity Type:Individual
Prefix:DR
First Name:VITO
Middle Name:
Last Name:SPECIALE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 MIDLAND PKWY
Mailing Address - Street 2:B
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8104
Mailing Address - Country:US
Mailing Address - Phone:843-851-9069
Mailing Address - Fax:843-871-8248
Practice Address - Street 1:299 MIDLAND PKWY
Practice Address - Street 2:B
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8104
Practice Address - Country:US
Practice Address - Phone:843-851-9069
Practice Address - Fax:843-871-8248
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1690213E00000X
SC628213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166218101Medicaid
SCSC07238550Medicare UPIN
TXU00409Medicare UPIN
TX8C0681Medicare ID - Type Unspecified