Provider Demographics
NPI:1568454205
Name:VILLAREAL, ROLLO P (MD)
Entity Type:Individual
Prefix:
First Name:ROLLO
Middle Name:P
Last Name:VILLAREAL
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 1:421 EPTING AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-4041
Mailing Address - Country:US
Mailing Address - Phone:864-227-6818
Mailing Address - Fax:864-227-0850
Practice Address - Street 1:421 EPTING AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-4041
Practice Address - Country:US
Practice Address - Phone:864-227-6818
Practice Address - Fax:864-227-0850
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23754207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT79233Medicaid
SCT79233Medicaid