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Contact Information

FREDY J REVILLA, MD
200 PATEWOOD DR STE B350
GREENVILLE, SC29615-6337
 Phone: 864-454-4500
 Fax: 864-454-4505
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Neurology

2084N0400X 13 Physician/Neurology
Indicates primary specialty

NPI Profile & details for FREDY J REVILLA · (Male)

NPI Number 1760418610
Status Active
Credentials MD
Entity Individual
Enumeration date 06/23/2006
Last updated 06/29/2021 - About 5 years ago
Sole proprietor 1 No
Identifiers
  • OH License # 35083417
  • SC License # 37641
  • OH Medicaid 2463614
  • SC Medicaid 376417
  • OH Other P00113175 MEDICARE RAILROAD
Hospital affiliation(s)
  • GREENVILLE MEMORIAL HOSPITAL - (Acute Care)
    701 GROVE RD
    GREENVILLE, SC 29605
  • GREER MEMORIAL HOSPITAL - (Acute Care)
    830 SOUTH BUNCOMBE ROAD
    GREER, SC 29650
  • HILLCREST MEMORIAL HOSPITAL - (Acute Care)
    729 SOUTH EAST MAIN STREET
    SIMPSONVILLE, SC 29681
  • PATEWOOD MEMORIAL HOSPITAL - (Acute Care)
    175 PATEWOOD DRIVE
    GREENVILLE, SC 29615
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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