Provider Demographics
NPI:1396747390
Name:SARMIENTO, EMMANUEL U (MD)
Entity type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:U
Last Name:SARMIENTO
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 1:1202 E BUTLER RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5910
Mailing Address - Country:US
Mailing Address - Phone:864-627-3800
Mailing Address - Fax:864-672-2654
Practice Address - Street 1:1202 E BUTLER RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5910
Practice Address - Country:US
Practice Address - Phone:864-627-3800
Practice Address - Fax:864-672-2654
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16400207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC164002Medicaid
F49222Medicare UPIN
SC164002Medicaid