Provider Demographics
NPI:1184735409
Name:VIGLIANCO-VANPELT, MICHELLE RENE (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENE
Last Name:VIGLIANCO-VANPELT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:
Practice Address - Street 1:325 MEDICAL PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-2457
Practice Address - Country:US
Practice Address - Phone:864-797-9300
Practice Address - Fax:864-849-9196
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28632208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC195798OtherMEDCOST
SC7520445OtherAETNA
SC286327Medicaid
SCAA31807951Medicare PIN
SC286327Medicaid