Provider Demographics
NPI:1891771812
Name:ESPAILLAT, ALEJANDRO (MD)
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:
Last Name:ESPAILLAT
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 1:300 E MCBEE AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2899
Mailing Address - Country:US
Mailing Address - Phone:864-522-8611
Mailing Address - Fax:
Practice Address - Street 1:100 PALMETTO HEALTH PKWY STE 350
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-1756
Practice Address - Country:US
Practice Address - Phone:803-907-2020
Practice Address - Fax:803-907-7720
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC93961207W00000X
FLME81887207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101886300Medicaid
207W00000XOtherTAXONOMY CODE
FL101886300Medicaid
E5584TOtherPTAN
449-9224OtherECFMG
FLME81887OtherMEDICAL LICENSE
10727084OtherCAQH
E5584TOtherPTAN
H37912Medicare UPIN