Provider Demographics
NPI:1740791268
Name:SPAGNOLO, GREGORIO O'NEILL (PA-C)
Entity type:Individual
Prefix:MR
First Name:GREGORIO
Middle Name:O'NEILL
Last Name:SPAGNOLO
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-695-6697
Mailing Address - Fax:
Practice Address - Street 1:1210 W FARIS RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4444
Practice Address - Country:US
Practice Address - Phone:864-522-1800
Practice Address - Fax:864-522-1806
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2847363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant