Healthcare Provider Details

I. General information

NPI: 1134534548
Provider Name (Legal Business Name): KENNETH RAPP III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 BORTHWICK AVE
PORTSMOUTH NH
03801-7128
US

IV. Provider business mailing address

35 YUMA LN
RINGWOOD NJ
07456-1225
US

V. Phone/Fax

Practice location:
  • Phone: 603-433-4012
  • Fax:
Mailing address:
  • Phone: 973-997-1160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number18270
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: