Provider Demographics
NPI:1396926978
Name:WAYNE C VIAL MD PA
Entity type:Organization
Organization Name:WAYNE C VIAL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:VIAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-884-4507
Mailing Address - Street 1:297 HOBCAW DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-2570
Mailing Address - Country:US
Mailing Address - Phone:843-884-4507
Mailing Address - Fax:843-881-2269
Practice Address - Street 1:1867 SAVAGE RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4726
Practice Address - Country:US
Practice Address - Phone:843-763-5866
Practice Address - Fax:843-763-8742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13429207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty