Healthcare Provider Details

I. General information

NPI: 1174963953
Provider Name (Legal Business Name): MAXIMILIEN JACOB RAPPAPORT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 W FARIS RD STE D
GREENVILLE SC
29605-4296
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-9031
  • Fax:
Mailing address:
  • Phone: 864-522-8617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLL35708
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number02004827A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number35708
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: