Healthcare Provider Details

I. General information

NPI: 1174151328
Provider Name (Legal Business Name): ZACHARY WALLACE RUPP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE, ML 3014
CINCINNATI OH
45229
US

IV. Provider business mailing address

7208 TOPAZ DR
CINCINNATI OH
45230-2262
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4788
  • Fax: 513-636-4283
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.151552
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number35.151552
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: