Healthcare Provider Details

I. General information

NPI: 1164592416
Provider Name (Legal Business Name): GARRY H RUPP MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5877 CLEVELAND AVE
COLUMBUS OH
43231
US

IV. Provider business mailing address

PO BOX 183027 DEPT LB-05
COLUMBUS OH
43218-3027
US

V. Phone/Fax

Practice location:
  • Phone: 614-891-0550
  • Fax: 614-891-0429
Mailing address:
  • Phone: 614-891-0550
  • Fax: 614-891-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GARRY H RUPP
Title or Position: PRESIDENT
Credential: MD
Phone: 614-891-0550