Provider Demographics
NPI:1164518494
Name:PRIJOLES, ELOISE J (MD)
Entity Type:Individual
Prefix:
First Name:ELOISE
Middle Name:J
Last Name:PRIJOLES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 GREGOR MENDEL CIR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-2316
Mailing Address - Country:US
Mailing Address - Phone:864-941-8100
Mailing Address - Fax:864-388-1052
Practice Address - Street 1:1911 THURMOND MALL
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2375
Practice Address - Country:US
Practice Address - Phone:803-799-5390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD23944207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276815100Medicaid
FL59232OtherBCBS
FL59232OtherBCBS