Provider Demographics
NPI:1447249461
Name:MOSCATELLO, SALVATORE ANTHONY (DO)
Entity type:Individual
Prefix:
First Name:SALVATORE
Middle Name:ANTHONY
Last Name:MOSCATELLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:SALVATORE
Other - Middle Name:A
Other - Last Name:MOSCATELLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:9221 UNIVERSITY BLVD
Mailing Address - Street 2:STE. 310
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9148
Mailing Address - Country:US
Mailing Address - Phone:843-576-0700
Mailing Address - Fax:
Practice Address - Street 1:9221 UNIVERSITY BLVD
Practice Address - Street 2:STE. 310
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9148
Practice Address - Country:US
Practice Address - Phone:843-576-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101280207207RG0100X
SC0331207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC003310Medicaid
E10675Medicare UPIN
E10675Medicare UPIN