Provider Demographics
NPI:1134515042
Name:PFLUGRATH, ADAM E (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:E
Last Name:PFLUGRATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 HALTON RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3403
Mailing Address - Country:US
Mailing Address - Phone:864-458-7956
Mailing Address - Fax:864-458-8390
Practice Address - Street 1:5 STEVENS ST STE 100
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4528
Practice Address - Country:US
Practice Address - Phone:864-250-6487
Practice Address - Fax:864-250-6475
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC85225207W00000X, 207WX0107X
TN59011207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC852250Medicaid