Provider Demographics
NPI:1962955690
Name:VAGLIO, REBECCA MARIE (MMS, PA-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:VAGLIO
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 SMITHFIELD WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-6956
Mailing Address - Country:US
Mailing Address - Phone:803-220-2782
Mailing Address - Fax:803-233-2968
Practice Address - Street 1:908 SMITHFIELD WAY STE 101
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-6956
Practice Address - Country:US
Practice Address - Phone:803-220-2782
Practice Address - Fax:803-233-2968
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06634363A00000X
SCPA4658363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant