Provider Demographics
NPI:1912956913
Name:VIAL, WAYNE CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:CHARLES
Last Name:VIAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:297 HOBCAW DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-2570
Mailing Address - Country:US
Mailing Address - Phone:843-763-5866
Mailing Address - Fax:843-763-8742
Practice Address - Street 1:1300 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 130
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3204
Practice Address - Country:US
Practice Address - Phone:843-881-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13427207RP1001X
SC13429207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCB925766986Medicare PIN