Provider Demographics
NPI:1932163466
Name:PINILLA, OMAR ADOLIO (MD,)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:ADOLIO
Last Name:PINILLA
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:PO BOX 52990
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-0048
Mailing Address - Country:US
Mailing Address - Phone:864-223-3600
Mailing Address - Fax:864-223-6054
Practice Address - Street 1:129 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4949
Practice Address - Country:US
Practice Address - Phone:803-778-9166
Practice Address - Fax:803-778-9551
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7250207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC072502Medicaid
B92671Medicare UPIN